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2013 Late-Enrollment Premium Penalties Will Increase Just Slightly

Late Enrollment Penalty (LEP) · published Aug 12, 2012

If you have accrued a monthly late-enrollment premium penalty, you can expect to pay slightly more of a penalty in 2013.  The late-enrollment penalty is an additional monthly cost paid by Medicare Part D beneficiaries who did not enroll in a Medicare Part D prescription drug plan when they were first eligible or who were without creditable prescription drug coverage for more than 63 days.

If you are subject to a late-enrollment penalty, you will pay your monthly Medicare Part D plan premiums along with an additional penalty calculated as one percent (1%) of the national average monthly premium for each month you were without creditable prescription drug coverage.  Please note, in certain situations, you can appeal your Late-Enrollment Penalty.

As a reminder, the CMS estimated weighted average Medicare Part D premium listed in the section above is not used for purposes of calculating the late-enrollment penalty.  Instead, the actual (non-weighted) Part D base beneficiary premium (or national base monthly Medicare Part D premium figure) is used to determine the amount of your late-enrollment penalty.

In 2013, the average monthly premium used to calculate the late-enrollment penalty will be $31.17 (or around $31), up slightly from the 2012 figure, but still less than 2011.  As reference, here are the premium values used to calculate the late-enrollment penalties from past years:

  • 2013: $31.17
  • 2012: $31.08
  • 2011: $32.34
  • 2010: $31.94
  • 2009: $30.36
  • 2008: $27.93
  • 2007: $27.35
  • 2006: $32.00


Example of estimating your 2013 Late-Enrollment Penalty:

If you were previously without creditable prescription drug coverage for five years (60 months), you would pay a 2013 monthly penalty in additional to your monthly premium estimated as 60% of $31.17 = $18.70 per month or around $224 per year.  In this same example, your current 2012 extra penalty payment should be around $18.64 per month.  Click here if you would like to read more on the Medicare Part D late-enrollment penalty.

Note: No late-enrollment penalties are assessed for people who qualify for the Medicare Part D financial Extra-Help program.

Do you still have a question about your Medicare Part D coverage?  Click here to let us know.