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Medicare Part D Late Enrollment Penalty


You may wonder if you need Medicare Part D prescription drug coverage if you are taking Original Medicare. When you have Medicare, you can get help paying for your prescriptions under Medicare Part D. There is an annual charge for Medicare Part D, but it is worth it to get your prescriptions at a discount.

If you don’t take medication or your out-of-pocket prescription costs are low, this coverage may seem like a waste of money. Refusing to enroll in Medicare Part D for an extended period may result in an additional penalty.

As a result, delaying Medicare prescription drug coverage can be costly, depending on your individual circumstances.. If you unexpectedly become unwell, your insurance may not cover the cost of your prescription. If you wait too long to enroll in Medicare Part D, you may be subject to a late enrollment penalty. Each month, you’ll pay more out of pocket, and the costs keep rising as you delay treatment.

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hat is the Medicare Part D Late Enrollment Penalty?

In addition to your monthly Medicare Part D premium, you will also have to pay the Medicare Part D late enrollment penalty. To calculate this surcharge, we used the average national Medicare Part D premium for the most recent year.

You will be penalized 1 percent of the average monthly Medicare Part D payment for every month that you did not have adequate medication coverage when you first became eligible. Beneficiaries who don’t have creditable coverage—that is, drug coverage at least as good as that provided by a Medicare Part D plan—will be subject to the penalty.

An Initial Enrollment Period (IEP) allows you to enroll in Original Medicare for the first time once you turn 65 and become eligible for the program. Medicare Part D is available to those who have Original Medicare.

On the first day of the month preceding your 65th birthday, you are eligible for Medicare’s Initial Enrollment Period. Third month after your birth month is when it ends. During this time period, if you do not have adequate prescription medication coverage, you must enroll in Medicare Part D to avoid a penalty.

After your Initial Enrollment Period, you will pay the Medicare Part D late penalty if you go without one of these types of drug plans for 63 days or more:

  • A Medicare Advantage plan
  • Part C of Medicare, the Medicare Advantage Prescription Drug Plan (MAPD), provides prescription drug coverage.
  • Prescription drug coverage under another health plan at least on par with Medicare’s level

The following are examples of respectable drug plans:

  • Employer drug coverage
  • Union drug coverage
  • Group drug coverage
  • VA drug coverage

Is There a Medicare Part D Penalty Under 65?

Medicare Part D penalties apply if you postpone signing up for prescription coverage after turning 65 because you qualify for Medicare because of a disability. A Medicare Part D penalty can be avoided if you’re aware of how eligible you are, know when your Medicare Part A coverage begins, and sign up right away.

The late enrollment penalties for Medicare are not waived because you are under the age of 65. After you become eligible for Medicare, if you do not have creditable medical or prescription medication coverage, you will be subject to the Part B and Part D fines. As a result, don’t put off signing up.

As a result, you will be able to start over with a clean slate when you reach the age of 65. In order to avoid more fines, you’ll have a second chance to sign up for Medicare Part D.

Medicare Part D Late Enrollment Penalty Calculator

In order to avoid a Medicare Part D penalty, you must have had a prescription drug plan that met the requirements of Original Medicare for at least six months. You will be charged an extra 1% of the current national base beneficiary premium, which is the average cost of Medicare Part D, for each month you do not have Medicare Part D or other comparable coverage.

The average premium for 2022 is $33.

Because of this, the Medicare Part D penalty is not limited to one year and does not go away after that. For as long as you have Medicare prescription coverage, you will pay a monthly fee. The Medicare Part D penalty is added to your Part D payment and is rounded up to the nearest tenth of a cent.

In order to keep up with the ever-changing Medicare Part D penalty, the current year’s national base premium must be taken into account. The Medicare Part D penalty can be difficult to calculate. Here’s an example to show you how it works in action:

Let’s say you were eligible for Medicare during the Initial Enrollment Period but didn’t sign up for Part D for another 24 months. As a result, you will be penalized 24 percent of the national basic Medicare Part D payment for each of the 24 months that you opted out of the program.

As a result, $33 x.24 = $7.90 (rounded to the nearest 10 cents) is the final result.

So, in addition to paying your Medicare Part D premium, you also have to pay monthly penalties. You can avoid paying the Medicare Part D penalty by signing up for a prescription medication plan the moment you are eligible for Medicare.

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Medicare Part D Penalty Appeal

An appeal is possible if you are responsible for the Medicare Part D penalty. All you have to do is fill out a form asking for a second chance. CMS.gov hosts this form.

You may also be eligible for Medicare Part D penalty help if you meet the Extra Help criteria. The penalty is waived for some low-income beneficiaries. You can apply for Medicare Extra Help by contacting Social Security.

Medicare Part D Penalty FAQs

What is the Medicare Part D penalty cap?
Due to the fact that this penalty did not begin until 2006, your punishment can only begin in 2006. Otherwise, the Medicare Part D penalty has no ceiling, so if you have no coverage for 100 months after becoming eligible for Medicare, you will pay your plan’s premium plus the national average Medicare Part D premium.
Does the Medicare Part D penalty go away when you turn 65?
Medicare Part D penalties paid prior to age 65 will not affect your eligibility for Medicare after you reach that age. As a result, it is best to get prescription drug coverage as soon as you are eligible after 24 months of receiving Social Security Disability (SSDI) benefits and at the age of 65. Many Medicare beneficiaries under the age of 65 are able to obtain low-cost prescription medication coverage through a Medicare Advantage MAPD plan.
How do I get rid of the Medicare Part D penalty?
There is no foolproof way to avoid the Medicare Part D penalty, alas. CMS.gov, on the other hand, has a form for requesting a reconsideration.

How to Avoid the Medicare Part D Penalty

It is essential to plan ahead in order to avoid penalties and keep costs down while deciding on Medicare coverage. MedicareFAQ ensures that our clients get the best plans and sign up on time.

Research the best plans in your area to establish your needs and get prices for your ideal coverage. You can reach us at the phone shown above, or you can use our online rate form to get started comparing plans right away.


  1. Part D late enrollment penalty, Medicare. Accessed June 2022.
  2. 3 ways to avoid the Part D late enrollment penalty, Medicare. Accessed June 2022.

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