What?? Not Enrolling in Medicare Part D Caused a Penalty?

Hello Toni:

I received a notice from CMS (Medicare) saying they do not have record of me having prescription drug coverage that “met Medicare’s minimum standards from 8/1/2017 to 1/1/2020 and I may receive a Part D late enrollment penalty. My HR director told me not to worry because the employer health plan has creditable coverage. Now I am receiving a Late Enrollment Penalty.

I thought creditable coverage kept me from a Part B penalty.  Now I am finding that was wrong. How am I getting a Part D late enrollment penalty? I did not enroll in a prescription drug plan immediately because I had a 90-day supply for my prescriptions. Now I must wait until Medicare Annual Enrollment this fall to enroll in a Part D plan.

Bad news is I’ll have a Part D penalty forever!!! This doesn’t seem fair! Sydney from Atlanta, GA

Sydney:

You waited too long to apply for a Medicare Part D plan when leaving employer benefits. Once you are past 65 and leaving creditable employer coverage, Medicare gives you 63 days not 70 or 90 days to apply for a Medicare Part D or Medicare Advantage plan with prescription drug coverage.

I hate to inform you, but not needing to order your prescriptions does not keep you from receiving Part D penalties.  You must enroll within Medicare’s specific timeline of 63 days.

Your late enrollment period (LEP) does not start from the day you lose or leave your company health plan, BUT from the month you turned 65 or began your Medicare and is based on when Part A of Medicare begins not Part B.

This LEP (late enrollment period) penalty enrolling penalty rules are:

• You waited past 63 days without creditable prescription drug coverage when you are leaving company benefits and you are older than 65 years old and 90 days. Don’t wait past 63 days to get Part D when leaving company health plans.
• Your company prescription drug benefits (not health benefits) are not creditable as Medicare declares.
• You simply never enrolled in Medicare Part D when you were first eligible and want to enroll.

Americans retiring after 65, that are leaving company health plans and applying for Medicare Parts A and B must prove they have “creditable coverage” when applying for Medicare Part D prescription drug plan only.

The Medicare & You handbook states: “Creditable prescription drug coverage could include drug coverage from a current or former employer or union, TRICARE, Indian Health Service, the VA or health insurance coverage.  Your plan must tell you each year if your drug coverage is “creditable coverage”.  This information may be sent to you in a letter or included in a newsletter from the plan.  Keep this information because you may need it when or if you join a Medicare drug plan late.”

Sidney, your company prescription drug benefits met Medicare’s “creditable coverage” rule, but you waited past the 63-day window to apply.  Now you have been denied coverage due to Medicare’s LEP (late enrollment penalty) rule and will receive a Part D penalty when you can apply. You must wait until the next Medicare Open/Annual Enrollment period from October 15-December 7 to enroll in a Medicare Part D prescription drug plan with your effective date to be January 1,  The Part D plan can be either stand-alone or a Medicare Advantage with Prescription Drug coverage.

Is the maze of Medicare confusing you? Call the Toni Says® Medicare hotline at 832-519-8664.

Toni King, author of the Medicare Survival Guide® is giving a $5 discount on the  Medicare Survival Guide® Advanced book to the Toni Says Medicare column readers at www.tonisays.com.