A non-government resource for the Medicare community
Powered by Q1Group LLC
A non-government Medicare community resource

How do I calculate my Medicare Part D Late-Enrollment Penalty?

Category: Late-Enrollment Penalty (LEP)
Updated: Apr, 05 2023

Your Medicare Part D late-enrollment penalty is calculated by multiplying the number of months you are without some form of "creditable" prescription drug coverage by 1% of the annual base Medicare Part D premium ($32.74 in 2023).

Example (for 2023 penalty):  Calculating a five-year late-enrollment penalty

As shown in the table below, the 2023 national base Medicare Part D premium is $32.74.  So, if you were previously without some form of creditable prescription drug coverage for five years (or 60 months), you would pay, in addition to your monthly Medicare plan premium, a 2023 monthly penalty of $19.60 (60 months x (1% x $32.74)) - or an additional $235 per year.

As reference, here are the average national base Medicare Part D premium values used by Medicare to calculate the late-enrollment penalties for past years:

  • 2014: $32.42
  • 2013: $31.17
  • 2012: $31.08
  • 2011: $32.34
  • 2010: $31.94
  • 2009: $30.36
  • 2008: $27.93
  • 2007: $27.35
  • 2006: $32.20

Question:  Can my late-enrollment penalty can change year-to-year?

Yes.  The late-enrollment penalty is permanent and can fluctuate every year based on the national average base Medicare Part D premium.  As another example, if you were eligible for Medicare, but without creditable prescription drug coverage from 2006 through 2010 (55 months without drug coverage) and then joined a Medicare Part D plan in 2011, you would pay a monthly penalty of $17.80 (55 months without drug coverage * 1% of $32.34 (the national base premium for 2011) - rounded to the nearest $0.10) or around an additional $214 over the year for your drug coverage.

In comparison, your 2023 penalty would be slightly higher or $18.00 per month (55 months without drug coverage * 1% of $32.74 (the national base premium for 2023) - rounded to the nearest $0.10) or around an additional $216 for the year.

If you stayed in a Medicare Part D plan since 2011, here is a chart showing how your 55-month late-enrollment penalty would have changed over the years (2011 to 2023).

Example_of_how_a_Medicare_Part D_Late_Enrollment_Penalty_changes

Question:  If I never joined a Medicare drug plan, can my late-enrollment penalty increase over time?

Yes.  In 2023, the maximum late-enrollment penalty can reach as high as $782.40 per year - paid in addition to your Medicare plan premium and coverage. Here is an example chart showing how a Medicare Part D late-enrollment penalty can increase over the years - and the cost of waiting to enroll in a Part D plan.

This chart is assuming that the Medicare beneficiary was eligible for a Medicare Part D plan back in 2006, but decided not to join a Medicare prescription drug plan until 2023.

Max Late-enrollment penalty accrued since 2006

Not a big fan of math?  No problem.

The amount of your Medicare Part D late-enrollment premium penalty is calculated each year by the Centers for Medicare and Medicaid Services (CMS) and then reported by CMS to your Medicare Part D plan or Medicare Advantage plan.

Your Medicare Part D plan will then send you a letter regarding the amount of your penalty.  So, CMS or Medicare will calculate your Part D Late Enrollment Penalty by totaling the number of months you have been without "creditable" prescription drug coverage and multiplying the total months by 1% of the national base average Medicare Part D premium which can change each year.

The letter from your Part D plan will also detail how CMS calculated the penalty and explain how you can ask for a review of your the Late-Enrollment Penalty (or LEP).

You can click here to read more about how CMS calculates Medicare Part D late-enrollment penalties.

Question:  Is everyone subject to the Part D late-enrollment penalty?

No.  In general, if you did not enroll into a Medicare Part D prescription drug plan during your Initial Enrollment Period (IEP) and you did not have other creditable prescription coverage (like VA or employer or union drug coverage), you could be subject to a penalty that is added to your monthly Medicare Part D premiums.  In addition, if you canceled your Medicare Part D plan or were without creditable prescription drug coverage for more than 63 days, you will also be subject to the premium penalty.

However, you will not be subject to a late-enrollment penalty if you are eligible for the Low-Income Subsidy (LIS) or Medicare Part D Extra Help program.

Question:  Will I pay a Part D late-enrollment penalty if I join a Medicare Advantage plan that includes drug coverage (MAPD)?

Yes.  You will pay a Medicare Part D late-enrollment penalty if you join a Medicare Advantage plan that includes drug coverage (MAPD).  However, if you join a Medicare Advantage plan without drug coverage (MA), you will not pay a Part D late-enrollment penalty since you do not have drug coverage.

Question:  What is "creditable" drug coverage?

"Creditable" prescription drug coverage means drug coverage that is at-least-as-good-as basic drug coverage provided by a Medicare Part D plan.  Some examples of creditable coverage are, VA coverage, TRICARE coverage, coverage from your Union healthcare, or employer health plan.  If you have employer drug coverage, your employer health plan administrator will have sent you a letter telling whether your drug coverage is "creditable".

Question:  What should I do if I don't believe that I should be paying a late-enrollment penalty?

You have the right to appeal your Medicare Part D late-enrollment penalty if you think that the penalty was wrongly assessed or miscalculated.  To learn more, we have detailed instructions online for appealing your late-enrollment penalty:  https://q1medicare.com/PartD-AppealMedicaresEnrollmentPenalty.php

You can begin by contacting your Medicare Part D plan using the toll-free number on your Member ID card and asking that the plan sends you a “Reconsideration Request Form” so that you can appeal your late-enrollment penalty.

You can also learn more from the federal contractor that handles Part D late-enrollment penalty appeals.  You can contact “C2C Innovative Solutions, Inc.” using the toll-free number (1-833-919-0198) or visit the website:

Late-enrollment Penalty articles

For more information, you can click here to review our recent articles detailing the late-enrollment penalty.

Late-enrollment Penalty Frequently Asked Questions (FAQs)

You can also click here if you would like to review more of our Frequently Asked Question (FAQ) regarding the Medicare Part D late-enrollment penalty.

Medicare Supplements
fill the gaps in your
Original Medicare
1. Enter Your ZIP Code:
» Medicare Supplement FAQs

Browse FAQ Categories

Ask a Pharmacist*
Have questions about your medication?

» Answers to Your Medication Questions, Free!
Available Monday - Friday
8am to 5pm MST
*A free service included with your no cost drug discount card.

Tips & Disclaimers
  • Q1Medicare®, Q1Rx®, and Q1Group® are registered Service Marks of Q1Group LLC and may not be used in any advertising, publicity, or for commercial purposes without the express authorization of Q1Group.
  • The Medicare Advantage and Medicare Part D prescription drug plan data on our site comes directly from Medicare and is subject to change.
  • Medicare has neither reviewed nor endorsed the information on our site.
  • We provide our Q1Medicare.com site for educational purposes and strive to present unbiased and accurate information. However, Q1Medicare is not intended as a substitute for your lawyer, doctor, healthcare provider, financial advisor, or pharmacist. For more information on your Medicare coverage, please be sure to seek legal, medical, pharmaceutical, or financial advice from a licensed professional or telephone Medicare at 1-800-633-4227.
  • We are an independent education, research, and technology company. We are not affiliated with any Medicare plan, plan carrier, healthcare provider, or insurance company. We are not compensated for Medicare plan enrollments. We do not sell leads or share your personal information.
  • Benefits, formulary, pharmacy network, provider network, premium and/or co-payments/co-insurance may change on January 1 of each year. Our PDPCompare.com and MACompare.com provide highlights of annual plan benefit changes.
  • The benefit information provided is a brief summary, not a complete description of benefits. For more information contact the plan.
  • Limitations, copayments, and restrictions may apply.
  • We make every effort to show all available Medicare Part D or Medicare Advantage plans in your service area. However, since our data is provided by Medicare, it is possible that this may not be a complete listing of plans available in your service area. For a complete listing please contact 1-800-MEDICARE (TTY users should call 1-877-486-2048), 24 hours a day/7 days a week or consult www.medicare.gov.
    Statement required by Medicare:
    "We do not offer every plan available in your area. Any information we provide is limited to those plans we do offer in your area. Please contact Medicare.gov or 1-800-MEDICARE to get information on all of your options."
  • When enrolling in a Medicare Advantage plan, you must continue to pay your Medicare Part B premium.
  • Medicare beneficiaries with higher incomes may be required to pay both a Medicare Part B and Medicare Part D Income Related Monthly Adjustment Amount (IRMAA). Read more on IRMAA.
  • Medicare Advantage plans that include prescription drug coverage (MAPDs) are considered Medicare Part D plans and members with higher incomes may be subject to the Medicare Part D Income Related Monthly Adjustment Amount (IRMAA), just as members in stand-alone Part D plans. In certain situations, you can appeal IRMAA.
  • You must be enrolled in both Medicare Part A and Part B to enroll in a Medicare Advantage plan. Members may enroll in a Medicare Advantage plan only during specific times of the year. Contact the Medicare plan for more information.
  • If you are enrolled in a Medicare plan with Part D prescription drug coverage, you may be eligible for financial Extra Help to assist with the payment of your prescription drug premiums and drug purchases. To see if you qualify for Extra Help, call: 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048, 24 hours a day/ 7 days a week or consult www.medicare.gov; the Social Security Office at 1-800-772-1213 between 7 a.m. and 7 p.m., Monday through Friday. TTY users should call, 1-800-325-0778; or your state Medicaid Office.
  • Medicare evaluates plans based on a 5-Star rating system. Star Ratings are calculated each year and may change from one year to the next.
  • A Medicare Advantage Private Fee-for-Service plan (PFFS) is not a Medicare supplement plan. Providers who do not contract with the plan are not required to see you except in an emergency.
  • Disclaimer for Institutional Special Needs Plan (SNP): This plan is available to anyone with Medicare who meets the Skilled Nursing Facility (SNF) level of care and resides in a nursing home.
  • Disclaimer for Dual Eligible (Medicare/Medicaid) Special Needs Plan (SNP): This plan is available to anyone who has both Medical Assistance from the State and Medicare. Premiums, co-pays, co-insurance, and deductibles may vary based on the level of Extra Help you receive. Please contact the plan for further details.
  • Disclaimer for Chronic Condition Special Needs Plan (SNP): This plan is available to anyone with Medicare who has been diagnosed with the plan specific Chronic Condition.
  • Medicare MSA Plans combine a high deductible Medicare Advantage Plan and a trust or custodial savings account (as defined and/or approved by the IRS). The plan deposits money from Medicare into the account. You can use this money to pay for your health care costs, but only Medicare-covered expenses count toward your deductible. The amount deposited is usually less than your deductible amount, so you generally have to pay out-of-pocket before your coverage begins.
  • Medicare MSA Plans do not cover prescription drugs. If you join a Medicare MSA Plan, you can also join any separate (stand-alone) Medicare Part D prescription drug plan
  • There are additional restrictions to join an MSA plan, and enrollment is generally for a full calendar year unless you meet certain exceptions. Those who disenroll during the calendar year will owe a portion of the account deposit back to the plan. Contact the plan provider for additional information.
  • Medicare beneficiaries may enroll through the CMS Medicare Online Enrollment Center located at www.medicare.gov.
  • Medicare beneficiaries can file a complaint with the Centers for Medicare & Medicaid Services by calling 1-800-MEDICARE 24 hours a day/7 days or using the medicare.gov site. Beneficiaries can appoint a representative by submitting CMS Form-1696.