Understanding Medicare Penalties for Late Enrollment

Enrolling in Medicare may be confusing, but one fact is clear – enrolling late in Medicare Parts A, B, or D can be costly. The initial enrollment period for Medicare Parts A and B lasts seven months and begins three months before your 65th birthday month.

Once that initial enrollment period ends, you have 62 days to choose a prescription drug plan. Late enrollment can lead to long-term Medicare penalties and delays in coverage.

So, should you worry? That depends:

If you claim Social Security benefits before your 65th birthday
You’ll be automatically enrolled in Medicare Parts A and B, with no risk of late enrollment. Keep in mind, you’ll still need to enroll in a drug plan on time to avoid a penalty.

If you are not claiming Social Security benefits before your 65th birthday and do not have alternate insurance
You need to be proactive about enrolling in Medicare. Contact Social Security to sign up for Medicare during the initial enrollment period (even if you don’t plan to claim Social Security benefits yet).

If you (or your spouse) are working past the age of 65 and use an employer group health plan,
You may be eligible for a special enrollment period. Then you can enroll in Medicare without a penalty anytime up to eight months after you stop working or your employer health plan ends (whichever comes first).

Read on to understand the penalties for each part of Medicare. Then consult with a Medicare insurance agent to ensure that you enroll in Medicare on time and without penalty.

Medicare Part A penalty

Not everyone is at risk for a Part A penalty. If you or your spouse worked for at least 10 years and paid the Medicare tax during that time, you’re entitled to Medicare Part A for free. With no premium, there is no penalty, no matter when you enroll.

If you are not eligible for premium-free Medicare Part A and did not sign up during the initial enrollment period, the penalty is a 10 percent increase to your monthly premium. In addition, the longer you wait to enroll in Medicare Part A, the longer the penalty lasts. You pay the higher premium for twice the number of years you waited to enroll. So, if you wait two years after the initial enrollment period to sign up, you pay the penalty for four years.

Medicare Part B penalty

The penalty for late enrollment in Medicare Part B is lifelong. For every full year that you delay Part B enrollment, your monthly premium increases 10 percent. You will pay this higher premium for as long as you have Medicare Part B.

Late enrollment for Medicare Part B also delays the start of your coverage. Once you miss the initial enrollment period, you cannot enroll in Part B until the general enrollment period (January 1 to March 31). Coverage does not start until July 1 of that year.

Medicare Part D penalty

After your initial enrollment period, Medicare requires you to add prescription drug coverage in a timely manner. If you go without coverage for a period of 63 continuous days or more, you’ll be penalized when you enroll in Medicare Part D. To avoid that penalty, you to need prove that you have acceptable prescription drug coverage, such as:

  • A Medicare Prescription Drug plan (Part D)
  • A Medicare Advantage plan (Part C) or another Medicare health plan that offers Medicare prescription drug coverage
  • Creditable prescription drug coverage

The cost of your Medicare Part D penalty depends on the length of time you went without prescription drug coverage. To calculate the penalty, Medicare multiplies 1% of the national base beneficiary premium times the number of full months without drug coverage. They round the penalty to the nearest $.10 and add it to your monthly Part D premium. The penalty changes year to year, as the national base beneficiary premium changes. Plan to pay the penalty as long as you have a Medicare drug plan.

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Schedule a personal consultation with a Highmark Medicare advisor or call 866-320-8359 , 7 days a week, 8 a.m. - 8 p.m. (ET), (TTY users call 711)

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Highmark Choice Company, Highmark Senior Health Company, and Highmark Senior Solutions Company are Medicare Advantage plans with a Medicare contract. HM Health Insurance Company is a PDP plan with a Medicare contract. Enrollment in Highmark Choice Company, Highmark Senior Health Company, Highmark Senior Solutions Company, and HM Health Insurance Company depends on contract renewal.

Health benefits or health benefit administration may be provided by or through Highmark Blue Cross Blue Shield, Highmark Choice Company, Highmark Senior Health  Company, Highmark Senior Solutions Company, or Highmark Health Insurance Company, all of which are independent licensees of the Blue Cross Blue Shield Association.  All references to “Highmark” in this document are references to the Highmark company that is providing the member’s health benefits or health benefit administration.