How to Appeal a PDP Late Enrollment Penalty?

[LostDollar]

He was on group plans for a number of years after turning 65, the problem is he did not keep good records of what coverages he had and when they ended.

If he did not take Part B until after group coverages ended, he would have had to have each employer complete a special form showing group coverage and effective dates, running from the time he turned 65 to the time of Part B application. (That is what I did.) If he had to do that and still has copies of the forms .......

Failing that, the next thing I would ask him to do is create a mymedicare account and check that for employer coverage information. It is possible the group coverage info was entered in his social security acct "behind his back" if you will, due to coordination of benefit issues. (My mymedicare acct shows group coverage since I turned 65 in much greater detail than I gave Soc Sec when I applied for part b.) I don't know if that information came from my part B app or was already in my account at the time I applied for part B, because I did not create my online account until later.

A third level effort might be to take a copy of that special part B application form around to each prior employer ask them to complete it.

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I got confused between mysocialsecurity and mymedicare.

My old group plans show in MYMEDICARE under the plans and coverage tab and the primary insurance subtab. (My group health plans were with large employers. Possibly small employer plans paying secondary to medicare would show in other insurance?)

 

[dnelson530]

I just had an 81 year old couple contact me to look at their coverage. They both had Plan G Sups they purchased at age 65, but no Part D coverage. They said their agent never mentioned it, nor the penalty, over the years. I know a lot of people say "how could you not know" with all of the information you get in the mail from CMS, but how can seniors read everything they get in the mail that mentions medicare?

I have never done an appeal for the Part D Penalty and the official form does not seem to even allow you to appeal on that premise. Any thoughts?

 

[TwoCents]

I just had an 81 year old couple contact me to look at their coverage. They both had Plan G Sups they purchased at age 65, but no Part D coverage. They said their agent never mentioned it, nor the penalty, over the years. I know a lot of people say "how could you not know" with all of the information you get in the mail from CMS, but how can seniors read everything they get in the mail that mentions medicare?

I have never done an appeal for the Part D Penalty and the official form does not seem to even allow you to appeal on that premise. Any thoughts?

So in 16 years they couldn't open up Medicare & You? Have they enrolled into a PDP now and being assessed an LEP? You can't appeal something (the LEP) if something doesn't exist. If they've been assessed an LEP, all you can do is have them try, but I wouldn't get their hopes up.

 

[Chazm]

I just had an 81 year old couple contact me to look at their coverage. They both had Plan G Sups they purchased at age 65, but no Part D coverage. They said their agent never mentioned it, nor the penalty, over the years. I know a lot of people say "how could you not know" with all of the information you get in the mail from CMS, but how can seniors read everything they get in the mail that mentions medicare?

I have never done an appeal for the Part D Penalty and the official form does not seem to even allow you to appeal on that premise. Any thoughts?

Sounds like a waste of time to me. An appeal is for someone who shouldn’t be paying the penalty. They 100% should be paying the penalty. I’m sure they were told, said no thanks and didn’t care.

Tell them the average drug plan is around $30. That’s 16 years of not paying $30/month and that’s close to $6k each they have saved. Now it’s time to pay up.

 

[Northeast Agent]

Seniors talk to each other about Medicare all the time! Probably what happened was when they were turning 65 they were both healthy and either took no meds, or just generics. When they "did the math," and "ran the numbers," it made more financial sense to not buy a Part D at the time and just pay out-of-pocket. I've run into this several times.

I tell them when you first enroll in Medicare, even if you're not taking anything, just buy the cheapest plan out there. It'll keep you out of the penalty box later. Some people are totally delusional, thinking they'll be as healthy in their 80s and 90s. I don't get it.

 

[JustinTime]

If you would like to know what the maximum late enrollment Part D penalty would be for someone who has not enrolled in a PDP, but has been eligible since it first began I recommend checking out the link below. The key thing to note is that the late enrollment penalty actually started in June 2006 and now runs through December 2018 for a total of 151 months, and it brings the total late enrollment Part D penalty to $50.10 per month or $601.20 per year. I've tried looking for this on Medicare's website, but haven't been able to find it.

Q1Medicare.com News: Q1News.com/706.html

 

[TwoCents]

If you would like to know what the maximum late enrollment Part D penalty would be for someone who has not enrolled in a PDP, but has been eligible since it first began I recommend checking out the link below. The key thing to note is that the late enrollment penalty actually started in June 2006 and now runs through December 2018 for a total of 151 months. I've tried looking for this on Medicare's website, but haven't been able to find it.

Q1Medicare.com News: Q1News.com/706.html

I'll be sure to remember this on bar trivia night.

 

[LostDollar]

If you would like to know what the maximum late enrollment Part D penalty would be for someone who has not enrolled in a PDP, but has been eligible since it first began I recommend checking out the link below. The key thing to note is that the late enrollment penalty actually started in June 2006 and now runs through December 2018 for a total of 151 months, and it brings the total late enrollment Part D penalty to $50.10 per month or $601.20 per year. I've tried looking for this on Medicare's website, but haven't been able to find it.

Q1Medicare.com News: Q1News.com/706.html

With your post as a guideline, I found this:
(see IEP info starting at bottom of page 5)
https://www.cms.gov/Medicare/Eligib...CreditableCoverageandLEPGuidance_01_05_18.pdf

 

[Northeast Agent]

What about the ones who IRMAA would apply to? If they didn't enroll in Part D when first eligible, would SS still hit them with the Part D IRMAA as well as Part B, or not until if/when they later enrolled?

 

[LostDollar]

What about the ones who IRMAA would apply to? If they didn't enroll in Part D when first eligible, would SS still hit them with the Part D IRMAA as well as Part B, or not until if/when they later enrolled?

Q1Medicare.com FAQ: Q1FAQ.com/680.html