Part D Late Enrollment Penalty Reconsideration Notice
The Part D Late Enrollment Penalty reconsideration notice provides a detailed explanation of your right to request a reconsideration of your Late Enrollment Penalty. Your Medicare Part D plan must send you this notice when the plan first sends you a letter notifying you about the imposition of a Late Enrollment Penalty. Sample Part D Late Enrollment Penalty Reconsideration Notice
Who Can Ask for a Reconsideration?
You or someone you name to act for you (your representative) can ask for a reconsideration. If someone requests a reconsideration for you, he or she must send proof of his or her right to represent you with the request form. Proof could be a power of attorney form, a court order, or Form CMS-1696 (Appointment Of Representative)
How Do I Ask for a Reconsideration?
The reconsideration request form should have been sent with the Late Enrollment Penalty Reconsideration Notice (if you cannot find the reconsideration request form, please call the member services department for your Medicare Part D plan). Complete the form. Mail it to the address or fax it to the number listed on the form within 60 days from the date on the letter you got stating you had to pay a late enrollment penalty. You should also send any proof that supports your case, like information about previous creditable prescription drug coverage -- send only copies of your original support documents
If you wait more than 60 days, you must explain why your request is late. Medicare will decide if you had good cause to send a late request.
What Do I Need to Include with My Late Enrollment Penalty (LEP) Reconsideration Request?
- A completed, signed Late Enrollment Penalty (LEP) reconsideration request (keep a copy).
- Copies of information you believe may help your case.
- If you’ve named someone to act for you, a copy of the proof the individual can represent you.
: Do not send original documents.
Your Medicare drug plan will give you a reconsideration request form when it sends you the letter telling you that you have to pay a late enrollment penalty. Mail the completed form to the address, or fax it to the number listed on the form within 60 days from the date on the letter. You should also send any proof that supports your case, like
information about previous creditable prescription drug coverage.
Reconsideration of a Late Enrollment Penalty (LEP) is processed by an Independent Review Entity (IRE) which is also known as a Qualified Independent Contractor (QIC). The IRE/QIC handling Late Enrollment Penalty Reconsiderations is:
MAXIMUS Federal Services
Medicare Part D QIC
P.O. Box 991
Victor, NY 14564-0991
Fax numbers: (585) 869-3320
Toll free fax: (866) 589-5241
Customer Service: 585-425-5300
Toll Free Customer Service: 877-456-5302
If you need more information about requesting a reconsideration of your late enrollment penalty, call your Medicare drug plan. You also may visit www.medicare.gov, or call 1-800-MEDICARE (1-800-633-4227) for help. TTY users should call 1-877-486-2048.