Robert A. Di Ieso, Jr.
By Kerri Anne Renzulli
March 10, 2016

Q: I enrolled in Medicare Part A and B in 2011 but not D. Now I want to enroll in D and they say I have to pay a penalty for the rest of my life because I didn’t have creditable drug coverage for 55 months. Is there any way to avoid this? — Diana

A: There are two ways you might get out of paying a late enrollment penalty. But know that for most people, the penalty — which affects anyone who has gone without a Medicare Prescription Drug Plan for a period of 63 days or more after the initial enrollment period is over — is going to stick.

One possible out: You won’t need to pay the penalty if you opted out of Part D because you already have “creditable” prescription drug coverage, says Tatiana Fassieux, chair of the board of directors for California Health Advocates.

To be considered creditable, your plan must pay on average as much as the standard Medicare prescription drug coverage. If you have one of these plans — which could be through a current or former employer or union, TRICARE, Indian Health Service, the Department of Veterans Affairs, a Medicare Advantage plan that includes drug coverage, or another group health plan — you should get a notice every year from your healthcare provider explaining that your drug coverage is considered creditable. Keep this letter, recommends Fassieux, because you could need it if you join a Medicare drug plan later.

The other way you can skip the penalty, says Fassieux, is if you qualify for Medicare Part D’s Extra Help program, which helps low-income individuals afford their prescriptions. Late enrollment penalties don’t apply to this program’s participants, even if they’ve never had any drug coverage.

Without either of these outs, though, you’ll have to pay up — and the cost will depend on how long you went without drug coverage. Medicare multiplies 1% of the “national base beneficiary premium” by the number of full months you went uncovered, then adds that to your monthly Part D premium. The premium for 2016 is $34.10, though it can change each year. So for you, the penalty will be almost $19 a month — for a total monthly payment of about $53.

Think you’re getting hit unfairly? Ask Medicare for a “reconsideration.” You’ll need to fill out a form and send any proof that supports your case — here’s where that notice of creditable coverage comes in. If Medicare decides that all or part of your late enrollment penalty is wrong, it will remove or reduce the penalty, and you could receive a refund for any penalty amounts you’ve already paid.

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