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How Your Medicare Part D Late-Enrollment Penalty Is Calculated

how is medicare calculated

Written By: Mike Olmos | Licensed since 2010 Print

If you delay enrolling in a Medicare Part D prescription drug plan, you may be charged a late-enrollment penalty. Here is how that penalty is calculated and assessed:

  • When you enroll in a Part D prescription drug plan, the plan will calculate the number of full months you were eligible to enroll in a Part D prescription drug plan, but elected not to enroll.
  • The Part D plan then provides that information to the Medicare program.
  • Medicare then determines the late-enrollment penalty by multiplying 1% of the national base beneficiary premium by the number of months you were uncovered. Medicare rounds that number to the nearest $0.10.
  • This amount is added to your Part D prescription drug plan monthly premium.

The national base premium ($33.13 in 2015) may change each year, so your Medicare Part D late-enrollment penalty may vary from year to year.

Please be aware that you may wind up paying this penalty for as long as you’re enrolled in a drug plan. There are some exceptions to this. For example, say a disabled individual under the age of 65 was assessed a late-enrollment penalty. Upon turning age 65, that individual would have a subsequent initial enrollment period. And, if he or she is still enrolled in the Part D plan, the

late-enrollment penalty would be eliminated going forward.

Individuals who qualify for Medicare’s Low Income Subsidy, also known as the Extra Help program, are exempt from a Part D late-enrollment penalty.

Do you have other Medicare questions? I can help you get the answers you need for anything Medicare-related. If you’d like to reach out to me, there are several ways for you to do so.

  • Use my profile, which you can access by using the orange button below. This will give you a pretty good sense of my background.
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  • If you’d like to browse available plans in your area, use the blue Find Your Plan button on the right side of this page.
  • Have a question that needs to be answered quickly? Just call us and we can help you.

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Mike Olmos Licensed since 2010

Category: Insurance

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