It’s all about the Initial Enrollment Period. Miss it and you could face late penalties that could last as long as you have Medicare. There are not many ways to get rid of your Part B late penalty and the Part D late penalty. With that in mind, this is what you need to know.

The Initial Enrollment Period

You need to know when to enroll in Medicare so you can avoid these late penalties in the first place. When you turn 65, your Initial Enrollment Period starts three months before your birth month and ends three months after your birth month (7 months total).

If you work beyond 65, you may want to keep your employer-sponsored health plan instead. In that situation, you can delay your Initial Enrollment Period without facing late penalties but only if your employer hires the equivalent of 20 full-time employees or more. Your new Initial Enrollment Period (which will now be called a Special Enrollment Period) will start when you leave your job or you lose your health plan, whichever comes first.

When it comes to Part D, your sign up period is somewhat different. Once you sign up for Part B, you have 63 days to sign up for a Part D plan. You only have to do so if you do not already have creditable drug coverage, i.e., drug coverage that is as good as a basic Part D plan.

End-Stage Renal Disease and Qualifying Disabilities

Not everyone qualifies for Medicare based on age. People who qualify based on a disability will automatically be enrolled in Medicare on their 25th month of SSDI or Railroad Retirement Board benefits. This is great news because there’s no way you will get hit with a Part A or Part B late penalty. What you need to know you is that you will not be automatically enrolled in Part D. If you do not sign up on time for that and you don’t otherwise have creditable coverage, you could still face late penalties.

End-stage renal disease — kidney disease that needs dialysis or a kidney transplant — works a bit differently. Coverage starts based on when you start your dialysis or when you get a kidney transplant. Like other qualifying medical conditions, you will not be hit with Part B late penalties. However, because Part D plans are optional, you could Part D penalties if you do not sign up when you need to.

Don’t get me wrong. It’s still possible to get a Part B late penalty when you have these conditions. This could happen if you decide to drop your Medicare coverage for any reason. For example, you might choose to go on your spouse’s employer health plan instead. Medicare will start counting the number of months you did not have Medicare coverage but were eligible for it. If you sign up for Medicare again, you will get hit with hefty Part B penalties.

The good news is that you can get rid of your Part B and Part D late penalties when you turn 65. Be thankful for age-based Medicare!

Medicare Savings Programs and Extra Help

When you struggle to keep up with your Medicare costs, you should definitely check to see if you qualify for one of the four Medicare Savings Programs. Depending on which program you qualify for, you could get help paying your Part A and Part B premiums, deductibles, coinsurance, and copays. Reach out to your local Medicaid office to find out for more information about Medicare Savings Programs. Many states have online applications.

If you qualify for one of the Medicare Savings Program, you can get rid of your Part B penalty!

Similarly, there is financial assistance available for Part D. Eligibility for the Extra Help Part D Low-Income Subsidy (LIS) was expanded in 2022 when the Inflation Reduction Act passed. You can apply through the Social Security Administration. Check out the online application here. You also call them toll-free at 1-800-772-1213 (TTY 1-800-325-0778) or schedule a visit at your local SSA office.

If you qualify for Extra Help, you can get rid of your Part D penalty!

Equitable Relief

Medicare Savings Programs and Extra Help are not the only way for you to scrub away your late penalties. There may have been circumstances outside of your control that prevented you from signing up on time. If that happens, you can make an appeal for “equitable relief”. The following situations may have caused you to miss your Initial Enrollment Period. Not only will you get a new Special Enrollment Period to sign up, you will also get rid of your Part B (but not your Part D) late penalties.

• A federal employee did not give you accurate information about Medicare enrollment.
• There was a natural disaster or public health emergency, e.g., the COVID-19 pandemic triggered a Special Enrollment Period.
• You were given misinformation regarding a transition from a Healthcare Marketplace plan to Medicare.
• You were unable to reach someone at the Social Security Administration to discuss your enrollment options, e.g., a Special Enrollment Period was granted in 2022 because of a short-term phone issue at the SSA.

To find out if you qualify for equitable relief, reach out to Social Security (1-800-772-1213/TTY 1-800-325-0778) as soon as possible. Keep in mind some of the Special Enrollment Periods will have time limits. Be prepared to support your request with documentation. The Medicare Rights Center provides an excellent letter template you can use to make your request. Don’t forget to include reference to any Special Enrollment Periods that may apply to your situation.

If your request for equitable relief is approved, you have one last decision to make. You can start your Medicare coverage now and start paying Medicare premiums. Or you can get retroactive Medicare coverage from the time you would have been eligible. In that case, you will have to pay back any Medicare premiums that would have been due during that time.

 

Bogle, D. (2022). Equitable Relief for Medicare Enrollment and Disenrollment. Social Security Matters. https://blog.ssa.gov/equitable-relief-for-medicare-enrollment-and-disenrollment/

Equitable Relief: Navigating the Process. Medicare Rights Center. https://www.medicarerights.org/PartB-Enrollment-Toolkit/Equitable-Relief.pdf

H.R.5376 – 117th Congress (2021-2022): Inflation Reduction Act of 2022. Congress.gov. https://www.congress.gov/bill/117th-congress/house-bill/5376/text

Medicare Part B: Enrollment and Premiums. Congressional Research Service. https://crsreports.congress.gov/product/pdf/R/R40082

If you disagree with your late enrollment penalty. Medicare.gov. https://www.medicare.gov/claims-appeals/file-an-appeal/if-you-disagree-with-your-late-enrollment-penalty

SSA – POMS: HI 00805.721 – Equitable Relief for Certain Individuals Dually Enrolled in Both Medicare and a Marketplace Plan. SSA.gov. https://secure.ssa.gov/poms.nsf/lnx/0600805721