Did You Know: Late Enrollment Penalty

The late enrollment penalty for Medicare is charged by the Centers for Medicare & Medicaid Services (CMS). This penalty is added to your clients monthly premium if they didn't sign up for Medicare Part A, Part B, or Part D when they were first eligible and didn't have other creditable coverage.

If they believe they shouldn't have a late enrollment penalty, they can take the following steps to address it:

Starting January 1, 2025, there are two new Special Enrollment Periods (SEPs) for dually eligible individuals and those eligible for Extra Help (low-income subsidy):

1. Review the Notice: Carefully read the notice they received about the penalty. It should explain why the penalty was assessed. 
2. Gather Documentation: Collect any documents that support their case. This might include proof of other creditable coverage (like employer-sponsored insurance) during the period in question.
3. Request Reconsideration: Fill out the "Part D LEP Reconsideration Request Form" provided with their notice. This form allows them to formally request a review of the penalty decision. 
4. Submit the Form: Send the completed form and any supporting documents to the Independent Review Entity (IRE) as instructed on the form.
5. Follow Up: The IRE will review their request and notify them of their decision, usually within 90 days. 

Part D penalties will be invoiced with their carrier plan. This is not a carrier issue and not their determination, but they can help get it resolved.

Learn more: https://www.cms.gov/medicare/appeals-grievances/prescription-drug/late-enrollment-penalty-appeals