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What is the Medicare Part D late enrollment penalty?


The Medicare Part D late enrollment premium penalty (LEP) is an additional cost you will pay every month because you did not enroll into a Medicare Part D prescription drug plan when you were initially eligible for Medicare coverage or you were without Medicare drug coverage for a period of more than 63 days  - and you did not have any other creditable prescription coverage (drug coverage that was at least as comprehensive as Medicare Part D drug coverage, such as VA drug coverage, TRICARE, or employer healthcare benefits).

Calculating your Late Enrollment Penalty (LEP)

The Late Enrollment Penalty is calculated as an additional 1% of the average annual base Medicare Part D premium (for example, $33.19 in 2019) for every month that you were without creditable coverage.

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 (this changes each year).

For example, if you were without drug coverage for 10 months, in 2019 you would pay 10 months * 1% * $33.19 = around $3.30 per month that is paid in addition to your Medicare Part D premium.

The good news is that you do not need to calculate your Your Medicare Part D late enrollment premium penalty each year.  Your penalty is calculated by the Centers for Medicare and Medicaid Services (CMS) each year 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.

Please note, if your Medicare Part D LEP is permanent and can increase every year.

As reference, here are the national base average Medicare Part D premium values used by CMS to calculate the late enrollment penalties for past years:
  • 2019: $33.19
  • 2018: $35.02
  • 2017: $35.63
  • 2016: $34.10
  • 2015: $33.13
  • 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
And here are a few articles detailing how the late enrollment penalty changes each year.
Exception to the LEP:  The Medicare Part D Extra Help program

Please note, if you are eligible for Medicare Part D Extra Help (also known as the Low-Income Subsidy (LIS) program), you will not be subject to a late enrollment penalty - if you qualify for Medicare and Medicaid, you automatically qualify for the Medicare Part D Extra Help program.

Example: How do I estimate my five-year late-enrollment penalty?

As shown in the table above, the 2019 national base Medicare Part D premium is $33.19. So, if you were previously without creditable prescription drug coverage for five years (or 60 months), you would pay, in addition to your monthly Medicare plan premium, a 2019 monthly penalty of $19.91 (60 x (1% x $33.19)) - or an additional $252 per year. Using this same example, you would have paid a 2013 monthly penalty of $18.70 or about $238.92 per year.

The ever-increasing "cost of waiting" to enroll in a Medicare Part D plan.

The following "maximum penalty" chart emphasizes the possible costs you may incur if you do not have any other prescription drug coverage and delay enrollment your Medicare Part D plan.

Aside from the late-enrollment penalty, if you decide to postpone Medicare Part D enrollment and then find that you suddenly have prescription needs, you may need to wait until the annual Open Enrollment Period (starting October 15th and continuing through December 7th) to join a plan with coverage starting the next January 1st - and you will need to pay all of your prescription costs out-of-pocket until your Part D plan coverage starts.

Our suggestion - avoid the penalty:  Even if you currently use no prescription medications and are in good health, look at the monthly costs on our chart and consider enrolling in a Medicare Part D plan or Medicare Advantage plan with the lowest monthly premium (perhaps a Medicare Advantage plan that offers prescription drug coverage (MAPD) with a $0 premium).  And then just consider your Medicare Part D plan as other type of "insurance" that is available should you need it.

Increasing_Max_Late_Enrollment_Penalty.jpg

Appealing your late enrollment penalty

If you do not agree with your late enrollment penalty, you have the right to appeal your LEP .  When your Medicare Part D plan informs you about your penalty, you will also be told how you can appeal the penalty if it was wrongly assessed.  You can also learn more about LEP appeals by calling the Member Services department of your Medicare Part D plan or you can read more here:  https://q1medicare.com/PartD-AppealMedicaresEnrollmentPenalty.php

And to learn more about the LEP

For more information, you can click here if you would like to read more on the Medicare Part D late-enrollment penalty.

Also, you can learn more in our Blog articles about the Late Enrollment Penalty (LEP).








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Tips & Disclaimers
  • The Medicare Advantage and Medicare Part D prescription drug plan data on our site comes directly from Medicare and is subject to change.
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  • 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.
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  • 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.
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  • 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.
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  • 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.
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