Part D Late Enrollment Penalty

Appeals are handled by Maximus as a Federal Contractor.

Just fill out the form and wait…

Part D Late Enrollment Penalty Reconsideration Request Form

Appointment of Representative Form (CMS-1696)

Please be sure to read our main page on the penalities for late enrollment in Part D, so that you understand how and what Maximus is looking for you to prove in an appeal.

Email: [email protected]

Frequently-asked-questions  Part D in General

Q13. I have been told by my plan that I owe a penalty for enrolling late in the Medicare Prescription Drug Program. I do not think that this is correct.

How do I file an appeal?

If you are being charged a Late Enrollment Penalty (LEP), you may request an LEP Reconsideration appeal with MAXIMUS Federal Services, the Part D Qualified Independent Contractor. 

Part D Late Enrollment Penalty Reconsideration Request Form

An enrollee may use this form to request an appeal of a Late Enrollment Penalty decision. The enrollee must complete the form, sign it, and send it to the Independent Review Entity – Maximus as instructed in the form. *



Reconsideration Process Manual   I don’t see anything about LEP though


Maximus Appeals – Information

Medicare and You 2019 - Everything you want to knowMedicare and You 2019 #10050 - Everything you want to know * See their section on closing the donut hole

CHAPTER 4 Creditable Coverage Period
Determinations and the Late Enrollment Penalty

Creditable Coverage Period Determinations and the Late Enrollment Penalty

8 comments on “Maximus Appeals LEP Late Enrollment Penalty

  1. I retired in January 2018, at age 71.

    I’ve had Part D coverage from Company A from February 2018 through December 2018. Then I switched companies and enrolled with Company B. In Company B’s welcome letter, they said that my premium included a large late enrollment penalty, which they were basing on information from Company A.

    When I called both Company A and Medicare, I found that they were charging me a penalty based on the period from when I turned 65, in 2011, to when I enrolled in Company A, in 2018.

    But I was working during that time and had creditable drug coverage through my employer. Now I’ve obtained a Disclosure of Creditable Coverage for that period.

    I never noticed that Company A’s premium included a penalty. I don’t even know if they told me. But I think it’s too late to recover from Company A, and I’m OK with that.

    What I’d like is for the penalty to stop now and in the future.

    To get this done, is it enough to file a reconsideration request with Maximus, sending them my Disclosure and my enrollment letter from Company B? Or must I do something more?

    • I searched and searched – I don’t see anything else for you to do, besides complete the form and wait.

      I’d go ahead and ask for all your $$$ back.

      Here’s what the reconsideration form says:

      If it has been more than 60 days, explain your reason for delay on a separate sheet and send it with this form

  2. I have tried to find help from every Provider and Hospital I have experienced. I do not belong in the LEP program I was told to demand a refund my Medicare UHC or AARP that has been taking my money more than 86 months. I’ve been Employed since 8/96.

    I have been charged more than 90 times for the LEP. Presently I remain on disability and have been since the age of 49. I have called United Health Care going on years in addition to Medicare. Last week they show me with not fitting into that category. At this point I demand a rebate or good reason this mistake continues. Call Medicare that show I do not belong in the LEP group. I was On Medicare and covered by several RX plans until today. I have been abused by your system and a lot of money taken with no good reason. AARP Medicare has been charging a fee as long as I remember. Washington University has always covered me since 6/1986 when Rx programs were not offered. Please refund me the 86 plus payments and the ones you have charged me in error.

    • The proper venue to ask for your LEP to end, file an appeal, apply for a refund is with Maxiumus not this website. We are providing information only and if you want coverage for 2019 we can help you get that.

      Please provide a certificate of credible coverage

      Prescription drug coverage (for example, from an employer or union) that’s expected to pay, on average, at least as much as Medicare’s standard prescription drug coverage. People who have this kind of coverage when they become eligible for Medicare can generally keep that coverage without paying a penalty, if they decide to enroll in Medicare prescription drug coverage later.

      from Washington University showing that you’ve had coverage at least as good as the standard part d program.

      Be sure to read all the information * Medicare & You * Your Guide to Medicare Rx * on the Part D LEP so that you know how to present your case and in the proper venue, not in comments on this site.

      Here’s a sample notice of credible coverage. This is what you must show to Maximus. Without it, your just spinning your wheels.

      notice of credible coverage

      Here’s the Part D Late Enrollment Penalty (LEP) Reconsideration Request Form that gets filled out and sent to Maximus.

      reconsideration form

  3. I am being penalized for late enrollment

    I retired 2 years ago April I was fully insured until that time I don’t know how this could be.

    I need help with this I have been paying this extra fee for about 2 years now.

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