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
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.
Appealing your late enrollment penalty
If you do not agree with your late enrollment penalty, you have the right to appeal
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.phpAnd 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)