AVOID LATE 
ENROLLMENT PENALTIES

Part D Late 
Enrollment Penalty

The cost of the late enrollment penalty depends on how long you went without creditable prescription drug coverage.  


The late enrollment penalty is calculated by multiplying 1% of the "national base beneficiary premium" ($32.42 in 2014) times the number of full, uncovered months you were eligible but didn't join a Medicare Prescription Drug Plan and went without other creditable prescription drug coverage. The final amount is rounded to the nearest $.10 and added to your monthly premium.


The national base beneficiary premium may increase each year, so the penalty amount may also increase each year.


Your plan will tell you if you owe a penalty.  After you join a Medicare drug plan, the plan will tell you if you owe a penalty, and what your premium will be. You may have to pay this penalty for as long as you have a Medicare drug plan. If you had to pay a Part D late enrollment penalty before you turned 65, the penalty will be waived once you reach 65.  

NOTE:   If you get Extra Help, you don't pay the late enrollment penalty.
When you can enroll initially....
 What if you are late...
MEDICARE PART A
Any time after you are 64 years and nine (9) months old or otherwise become eligible for Medicare. Enrollment is automatic if you already get Social Security benefits.  Otherwise, you will have to enroll at your local Social Security Office.
There are no penalties for signing up late, unless you are one of the people who pay a monthly premium for Part A because neither you or nor your spouse contributed enough to Social Security.  Then you may pay a penalty on your premium for signing up late.
 MEDICARE PART B
Seven-month window--Any time from three months before you become eligible for Medicare until three months after your eligiblity month.
If you enroll after the initial enrollment period, premiums will be higher unless you qualify for an exception.  Contact Medicare 1-800-MEDICARE to learn more about exceptions. You may also contact Mountain State Senior Insurance Services at 304-201-0100 
 MEDICARE PART C
MEDICARE ADVANTAGE
Seven-month window--Any time from three months before your eligibility month until three months after your eligibility month.

If you miss the enrollment window, you must wait to enroll between October 15 and December 7, unless you qualify for an exception.  Please give us a call at 304-201-0100 to see if you qualify for an exception.
  MEDICARE PART D
Seven-month window--Any time from three months before your eligibility month until three months after your eligibility month.
If you miss the enrollment window, you must wait to enroll between October 15 and December 7, unless you qualify for an exception.  

Enroll later and premiums could be higher.

Late Enrollment Penalty (LEP)--The dollar amount added to your Part D premium.  If you did not have creditable drug coverage for 63 days or more an dyou did not enroll during your Initial Enrollment Period or the Open Enrollment Period, you will pay a LEP unless you qualify for an exception.

Call Medicare 1-800-MEDICARE or feel free to call Mountain State Senior Insurance Services at 1-304-201-0100 to see if you qualify for an exception.
MEDICARE SUPPLEMENT
Six-month window for guaranteed right--When you turn 65 and enroll in Medicare Part B, you have a right to buy a Medicare Supplement policy for six months.  You can not be refused if you sign up during this open enrollment period.
If you miss this six-month window, you may apply at any time.  However, you may be charged a higher rate or rejected if you have a health history that makes you appear to be a higher right.  

Please see Medigap Open Enrollment and Medigap Guarantee Issue for further explanation.

3 WAYS TO AVOID THE LATE ENROLLMENT PENALTY

1. Join a Medicare Prescription Drug Plan when you're first eligible.

You won't have to pay a penalty, even if you've never had prescription drug coverage before.


2. Don't go 63 days or more in a row without a Medicare drug plan or other creditable coverage.


NOTE:  Creditable prescription drug coverage could include drug coverage from a current or former employer or union, TRICARE, Indian Health Service, the Department of Veterans Affairs, or health insurance coverage. Your plan must tell you each year if your drug coverage is creditable coverage. They may send you this information in a letter, or draw your attention to it in a newsletter or other piece of correspondence. Keep this information because you may need it if you join a Medicare drug plan later. 


3. Tell your plan about any drug coverage you had if they ask about it.


When you join a Medicare drug plan, the plan will send you a letter if it believes you went 63 or more days in a row without other creditable prescription drug coverage. The letter will include a form asking about any drug coverage you had. Complete the form and return it to your drug plan by the deadline in the letter. If you don't tell the plan about your creditable drug coverage, you may have to pay a penalty.

MEDICARE PARTS A and B LATE ENROLLMENT PENALTIES

If you do not sign up for Part A when you are first eligible for Medicare, you may be subject to a penalty equal to 10% of the Part A premium. The 10% premium penalty applies regardless of how long the Part A enrollment delay is.  They will have to pay the premium penalty for twice the number of years they could have had Part A already, but did not sign up.


When a person doe not sign up for Part B when they are first eligible may they have to pay a late enrollment penalty. The monthly premium for Part B can go up 10% for each full 12-month period that the person could have had if they had signed up initially. The person will have to pay the premium penalty for a long as they are on Medicare.


If that person signs up during the Special Enrollment Period (SEP) there is usually no late penalty that is incurred during that time.


Source: Medicare.gov – Medicare Basics booklet -Page 17:http://www.medicare.gov/publications/pubs/pdf/11034.pdf


Medicare. Gov Handbook pg 24(Part A) and 25 (Part B):
http://www.medicare.gov/publications/pubs/pdf/10050.pdf

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