Part D Late Enrollment Penalty
Appeal Process?

How is the penalty calculated?

If you don’t buy Part D Rx when you are supposed to, as when you’re first eligible, going back to 1.2006 Wikipedia. there is a late enrollment  penalty LEP of 12%/year when you finally do Medicare & You, * Part D Rx Guide, * Medicare.Gov   

The penalty applies where there is  period of 63 or more days in a row when you don’t have Part D or other creditable prescription drug coverage

See also  eligibility   & Residence  if you lived outside the USA. See page 21 of Part D Rx Guide  for ways to avoid the penalty.

Amplicare.com
Part D Rx Late Enrollment Penalty Calculator

Medicare Part A Hospital & B Doctor Visits Eligibility & Premium Calculator

Eligibility & Premium Calculator

Our Webpage on Late  Penalties?

Our Webpage on High Income?

Amplicare.com
Part D Rx Late Enrollment Penalty Calculator

 

Video
How Part D Late Enrollment Penalty is calculated

 

Appeals form & Where to send it

 

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.  .  CMS.gov *     Just fill out the form and wait…  Be sure to read the form below for reasons to file an appeal.  There are not that many.

Smart Phone

Click on the link, If you don’t see the Part D Reconsideration Form

maximus
Maximus Appeals – Information

Consumer Links & Resources

Part D Prescription Drug Guide #11109 84 pages pdf

Medicare & You – See link in Side Panel

Explanation on Medicare’s Website

How to avoid penalty

Part D Late Enrollment Penalty Reconsideration Request Form cms.gov Appeals-and-Grievances/

Part D Rx 42 USC §1395 Late Enrollment Penalty on Cornell Law Website

Part D Late Enrollment Penalty Calculator

cms.gov/Late-Enrollment-Penalty-LEP-Appeals  

MEDICARE PRESCRIPTION DRUG
BENEFIT MANUAL
CHAPTER 4 Creditable Coverage Period
Determinations and the Late Enrollment Penalty

Creditable Coverage Period Determinations and the Late Enrollment Penalty

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FAQ from Calculation Page

Frequently-asked-questions
Part D in General

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?

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

 

  1. Part D Rx Prescriptions is included at no additional charge with my Medicare Advantage Plan, right? So, why do they charge me a late enrollment penalty?
     
  2. Social Security sent me a letter that I might get a late enrollment penalty as they don’t think I had credible employer coverage.

     

     

    How do I show them that I did?

     
    • From what I gather, your PDP Rx Carrier, should send you a “Declaration of Prior Prescription Drug Coverage” Exhibit # 1 D

       

       

      If you have further questions, you might try contacting:

      Rhonda GreeneBruce via e-mail at [email protected] or via telephone at (410) 786-7579

      What if I have questions?
      If you have questions about the information in this form or the late
      enrollment penalty [or would like to complete this form over the telephone],
      call your Medicare drug plan.


      You may also contact Medicare:
      • Visit http://www.medicare.gov on the web
      • Call 1-800-MEDICARE (1-800-633-4227)
      • TTY users call 1-877-486-2048.

       
      • I filled out the declaration and sent it to AARP – Symponex – A month ago April 11th. I haven’t heard from anyone. What’s the problem? Should I worry?
         
        • Unfortunately, IMHO AARP and Medicare.Gov think that they are the be all and end all in customer service and that brokers don’t add much to the equation. That is, they only pay brokers $50 1st year and $25 for renewal to help the public with the confusion they create. I blame it mostly on Medicare, with all their rules. On the other hand, considering the subsidies the Government is giving, I guess that entitles them a lot of control!

           

           

          The best answer I’ve rec’d is for the member – customer to wait on hold and talk to customer service:

          AARP Part D Customer Service at 1 (888) 867-5575

          Personally, I wouldn’t worry till I heard something.

           
  3. I am being charged a late enrolment penalty and feel this is unjustified.

     

     

    Please tell me what the very earliest date of Medicare Part D enrollment, year and month?

     
  4. Is there any way for us to Participate in Part “D” without paying the penalty for late filing [not enrolling when we were first eligible – 5.15.2006]?
     

Q & A

I am 75. When Part D became available I did not enroll because I found another supplier at a substantial discount. If I understand the program, I am now subject to a 1% per month penalty from the date I became eligible to join Part D or in my case about a 50% penalty on the premium cost. Can this be so? Of course when it comes to the U.S. government stupid is the norm. Lately I have found that as Generics become available, I can switch back to purchasing them at Costco at substantial discount.

So what happened to the $ 31.80 you quoted earlier?

I did not quote that. It’s from the Official Medicare Manual. “national base beneficiary premium” ($31.08 in 2012) Or was that the low premium in 2006?It changes ($32.34 in 2011) See the links below.

And on which the 1% is being calculated?

$31.08 Now it appears we are at $ 54.82 p/m or $657.84 per year for the “Standard” plan.  Math sounds close. The answer to the annual income from regular taxable earnings is less than $ 170,000.00. The good side is you do not have that “extra” tax. Can this figure be relied upon and have premiums increased by 19% since 2006?The penalty is only for the period of time that you have not been covered. So, it’s $15 forever.

On the other hand… Since the “national base beneficiary premium” may increase each year, the penalty amount may also increase every year. You may have to pay this penalty for as long as you have a Medicare drug plan. More Info. (Unfortunately, it says the exact same thing) .medicare.gov q1medicare.com

At 06:07 PM 4/30/2012,  Is that $ 31.08 X 50 months X 1% penalty per month = $ 15.52 for a total monthly premium of $ 47.34??????

***My numbers do not quite match, but the concept is correct. It would be $15.52 on top of what ever premium you choose. healthreformquotes.com/ Do you and your wife have more than $170k in income? healthreformquotes.com/

If I understand the program, I am now subject to a 1% per month penalty from the date I became eligible to join Part D or in my case about a 50% penalty on the premium cost. Can this be so?

***2006 Effective Date = 50 months x ($31,08/1%) = $15/month penalty

 

******************

 

Karen says:
I’m disabled & I get medicare.

I cant afford the late enrollment part D penalty. Can I get rid of this extra charge & what qualifies me to get help paying for or get rid of a monthly part D late enrollment penalty?

Reply

22 comments on “Maximus Appeals LEP Late Enrollment Penalty

  1. I’m disabled & I get medicare.

    I cant afford the late enrollment part D penalty. Can I get rid of this extra charge & what qualifies me to get help paying for or get rid of a monthly part D late enrollment penalty?

  2. I just got a letter from Clover on 01/10/2020 stating that I owe $516.40 which I am being penalized for some reason.

  3. i was charged $1.30 a month by humana which I paid for a year. I am also paid for 6 months this year although I do not have Humana any longer, I now have United health and they are charging me the same fee.

    I was not late enrolling in there plan.

    I resent paying that fee for a life time,

    I respectfully request that that charge be removed.

    • Humana nor United Health are charging you a late fee. It’s the Federal Government. This website is not the place to do an appeal.

      Please review the appeal form and see which exemption might apply to you.

      When were you first eligible to get Part D Rx?

      When did you first enroll?

      If you want our assistance, you must provide the documents. We do not go by hearsay or any statement or conclusion without documentation.

      The late enrollment penalty is an amount that’s added to your Part D premium if, at any time after your Part D Initial Enrollment Period is over, there’s a period of 63 or more days in a row when you don’t have Part D or other creditable prescription drug coverage.

      When can I join, switch, or drop a drug plan?

      ■ During your 7-month Initial Enrollment Period, when you first become eligible for Medicare. You can join a Medicare drug plan during the 7-month period that begins 3 months before you turn 65, includes the
      month you turn 65, and ends 3 months after the month you turn 65. If you join during 1 of the 3 months before you turn 65, your coverage will begin the first day of the month you turn 65. If you join during the month you turn 65 or 1 of the 3 months after you turn 65, your coverage will begin the first day of the month after you ask to join a plan. https://www.medicare.gov/Pubs/pdf/11109-Your-Guide-to-Medicare-Prescrip-Drug-Cov.pdf#pag=20

      Here’s a video on how the Part D Penalty is calculated

  4. I was told from Social Security back in March 2018 that all I needed was part A Hospital & B Doctor Visits when I no longer have coverage though work.

    They did ask me what prescriptions I was taking & I was not taking any so they said all I needed was part A&B.
    Now I am being told that I will have to pay a penalty because I did not have plan D.

    I would have gotten part D back then if they told me, but again all they said I needed was part A&B

    What is the right way to appeal this matter?

    • Hearsay and what someone was told, are things that scare me very much. I do not listen to it. I do not accept it. I’m afraid! Here’s our webpage on the dangers of hearsay. This is why, I follow up my phone conversations with an email giving links to the full details of what we spoke about. This is why, I don’t take phone calls, unless I’m told in advance, what the questions will be, so that I can look up and get an authoritative answer.

      Here’s the form to file an appeal, including where to mail it to. Getting wrong information from a Government Agency is not on the form.

      Check our research here about someone that went to Social Security, got all signed up on the very last day and then Social Security lost the paperwork.

  5. I signed up with Aetna Medicare Advantage Plan ($0 premium) starting June 1, 2019.

    I submitted a Declaration of prior prescription drug coverage form stating I had prior drug coverage from 6/1/2018 to 5/31/2019.

    Yesterday I received a premium payment book from Aetna to make payments to them.

    I was told I need to send in an appeal and they or the government wants to know if I had coverage from July 2017 to May 2018 (which I did with Blue Cross).

    I downloaded the “Part D Enrollment Penalty Reconsideration Request Form.

    Our office person is out all week so I can’t provide a copy of Notice of Creditable prescription Drug Coverage.

    So what can I do?

    This is really a pain to deal with.

  6. I never received a call from Maximus.

    I need to prepare explanation in reference to late enrollment

    • Judging from the information I’ve researched and put on this page, I don’t think Maximus will help you. All I can say is complete the forms to the best of your ability and send them in. Be sure to read all the instructions and if you want to do even better, the relevant information on this page and your own research. You might ask your agent/broker for help. You might also check with legal counsel, but there probably isn’t enough money involved.

      You might try HICAP in your state https://www.shiptacenter.org/

      Here’s CA’s website https://cahealthadvocates.org/

  7. 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

      • I thought I should let you know how this turned out. I submitted this same question to the government site’s chat feature (mymedicare.gov) and the representative could also think of nothing to do except to file the Maximus paperwork, including my Disclosure of Creditable Coverage. She thought that if my appeal was approved, I might send a letter to Company A asking for my LEP back.

        So I just filed the appeal, with my creditable coverage paper. I did not include any notes about the “reason for [my] delay,” since this feature seems to be about things like being too sick to file paperwork, not things like not noticing that you were paying a penalty.

        But it turned out well. A couple of days ago, I got a letter from Maximus that begins “The appeal decision is FAVORABLE [all caps in original].” The letter says that “[t]he Part D plan must report a revised creditable coverage period determination indicating zero (0) uncovered months to Centers for Medicare & Medicaid (CMS) …” It also says that they are telling the plans “listed below” to reimburse my LEP, and this list includes both Company B and Company A.

        So this is a happy ending, probably. I say “probably” for several reasons. First, it took them two months to reply and I still haven’t heard about my wife’s appeal, which I filed separately. She had creditable coverage as my dependent, so the same Disclosure applies to her. Second, I haven’t heard from either Company A or Company B about reimbursing me. But since I never really expected reimbursement, this is not important.

        I’m now pretty confident that things will turn out well. Thanks for your help.

  8. 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 http://www.medicarepartdappeals.com/ 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 above in our webpage * 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.

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

  9. 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.

    • Do you have proof of Creditable Coverage from your employer?

      Creditable prescription drug 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. Learn More ==> Guide to Medicare Rx Page 83

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