Late Enrollment Penalty

More Information on Part D Late Enrollment Penalty

What is the Part D late enrollment penalty?
The late enrollment penalty is an amount added to your monthly Medicare drug plan (Part D) premium for as long as you have Medicare prescription drug coverage. This penalty is required by law and is designed to encourage people to enroll in a Medicare drug plan when they are first eligible or keep other prescription drug coverage that meets Medicare's minimum standards.
  • You may owe a late enrollment penalty if you didn’t join a Medicare drug plan when you were first eligible for Medicare Part A and/or Part B, and:
  • You didn’t have other prescription drug coverage that met Medicare's minimum standards; OR
  • You had a break in coverage of at least 63 days.
How do I know if my prior prescription drug coverage met Medicare's minimum standards?
Most plans that offer prescription drug coverage, like plans from employers or unions, must send their members a notice explaining how their prescription drug coverage compares to Medicare prescription drug coverage. This notice tells you if the prescription drug coverage you had through your prior plan was "creditable prescription drug coverage," which means that it met Medicare’s minimum standards. If you didn’t get a separate written notice, your plan may have provided this information in its benefits handbook. If you don’t know if the prescription drug coverage you had met this standard, you should contact your prior plan.
What if I Don’t Agree with Medicare's Late Enrollment Penalty Decision?
"Creditable prescription drug coverage" is coverage (for example from an employer or union) that meets Medicare's minimum standards since it is expected to pay, on average, at least as much as Medicare's standard prescription drug coverage. If you don’t join a Medicare drug plan when you are first eligible, and you don’t have other "creditable prescription drug coverage", you may have to pay a late enrollment penalty (LEP). In some cases you have the right to ask Medicare to review your late enrollment penalty decision. This is called a "reconsideration". For example, you could request reconsideration if you think Medicare did not count all of your creditable coverage or if you didn’t get a notice that clearly explained whether your previous prescription drug coverage was creditable. Other reasons for requesting a reconsideration are listed on the request form sent with this 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 an "Appointment of Representative" form. You also can call the Medicare helpline (see below) and ask for Form CMS-1696.
What if I have questions?
If you have questions about the information in this form or the late enrollment penalty [or would like to complete this form over the telephone], call your Medicare drug plan.
Care1st Health Planat 1-800-544-0088, 8:00 a.m. to 8:00 p.m., seven days a week
Telecommunications device TTY for the hearing and speech impaired at 711
You may also contact Medicare:
Visit www.medicare.gov on the web
Call 1-800-MEDICARE (1-800-633-4227)
TTY users call 1-877-486-2048