LEP INCREASING?

[20th Maine]

enrolled new client on MAPD

They got letter stating their LEP was increasing by $4.80 a month

Clearly they HAVE B and were coming FROM another MAPD so they had D

Never heard of an LEP going "up?"

 

[vic120]

It is based on the national average cost of a drug plan, If that goes up I would assume the LEP would go up

I got an email from a client 20 minuets ago on this

This is what I think may be happing, they probably consider the national average to be higher then before

 

[20th Maine]

Dang OK ya never thought of that. Thank you Shanghai Joe!

 

[LostDollar]

See very bottom of quote box for relevant text:

How much is the Part D penalty?
The cost of the late enrollment penalty depends on how long you went without Part D or creditable prescription drug coverage.

Medicare calculates the penalty by multiplying 1% of the "national base beneficiary premium" ($34.70 in 2024)($36.78 in 2025) times the number of full, uncovered months you didn't have Part D or creditable coverage. The monthly penalty is rounded to the nearest $.10 and added to your monthly Part D premium.

The national base beneficiary premium may increase or decrease each year, so your penalty amount may also increase or decrease each year.

Part D late enrollment penalty

The cost of the Part D late enrollment penalty, which is determined based on how long you are without creditable prescription drug coverage

www.medicare.gov

 

[Riskfreak]

Ah, the dreaded LEP..

Here's what's going down: LEPs are based on the number of months someone went without credible Part D coverage. Even if your client had a MAPD, the penalty could increase if Medicare recalculated or discovered additional gaps in their Part D coverage history. Maybe a period they missed was recently uncovered. Yeah, it's sneaky, but it happens.

Now, here's your move. First, confirm their enrollment and coverage history. Did they always have a MAPD with drug coverage, or was there ever a break? Check their Medicare statements, because if Medicare is wrong, and trust me, they've been wrong before, you'll want to file an appeal.

If everything checks out and the increase is legit, well... it's annoying, but at least it's a small hit. Remind your client that keeping consistent coverage now means no more surprises later.

And if Medicare tries to play tough again, don't sweat it. You've got the Riskfreak's expertise in your corner. We'll straighten it out faster than you can say 'Part D deductible.' Now go show them who's boss.

 

[LostDollar]

If everything checks out and the increase is legit, well... it's annoying, but at least it's a small hit. Remind your client that keeping consistent coverage now means no more surprises later.

Caveat, not an agent.

I think that may be bad advice. CMS' documentation about the Part D LEP would suggest that it can have a "surprise" change each year.

 

[Riskfreak]

Caveat, not an agent.

I think that may be bad advice. CMS' documentation about the Part D LEP would suggest that it can have a "surprise" change each year.

Alright, LostDollar, you bring up an important nuance, and let's get real specific here to clear up any confusion, because the Riskfreak never dishes out bad advice. My E&O carrier knows it.

The Late Enrollment Penalty (LEP) for Medicare Part D is calculated as 1% of the national base beneficiary premium (NBBP) for each uncovered month without creditable Part D drug coverage. The key detail? The NBBP isn't static, it changes every year, and so does the penalty

Here's the technical breakdown:

• For 2023, the NBBP was $32.74, so the penalty was $0.3274 per month of non-coverage.
• For 2024, the NBBP increased to $34.70, raising the per-month penalty to $0.3470
  

Let's say a client had a 48-month gap in coverage:

• In 2023, their penalty would have been: 48 months × $0.3274 = $15.71 per month.
• In 2024, the penalty recalculates: 48 months × $0.3470 = $16.66 per month.

That's nearly a $1 per month increase without the client doing anything wrong. It's purely the result of the rising NBBP.

CMS recalculates the penalty annually to reflect the updated NBBP, which is based on the projected average premiums for standard Part D plans across the country. So, even if a person's coverage history hasn't changed, the penalty amount can go up (or down, hypothetically, if the NBBP decreases)

If the client is surprised by the increase, the first step is to verify the calculation. CMS is generally accurate, but if there's any suspicion of misreported months of non-coverage, the penalty could be appealed. However, in most cases, the increase is legitimate and driven by the updated NBBP.

So, no surprises there, but the Riskfreak is always about staying ahead of the game. When it comes to penalties, knowing the rules is half the battle. Anything else you need? You know where to find me.

Riskfreak out

 

[Ronnie Carter]

Ah, the dreaded LEP..

Here's what's going down: LEPs are based on the number of months someone went without credible Part D coverage. Even if your client had a MAPD, the penalty could increase if Medicare recalculated or discovered additional gaps in their Part D coverage history. Maybe a period they missed was recently uncovered. Yeah, it's sneaky, but it happens.

Now, here's your move. First, confirm their enrollment and coverage history. Did they always have a MAPD with drug coverage, or was there ever a break? Check their Medicare statements, because if Medicare is wrong, and trust me, they've been wrong before, you'll want to file an appeal.

If everything checks out and the increase is legit, well... it's annoying, but at least it's a small hit. Remind your client that keeping consistent coverage now means no more surprises later.

And if Medicare tries to play tough again, don't sweat it. You've got the Riskfreak's expertise in your corner. We'll straighten it out faster than you can say 'Part D deductible.' Now go show them who's boss.

"Credible" coverage, as in "believable?" Interesting that you spelled it correctly in the post just above this one.

Don't feel bad -- I was at a Humana event a few years back where the speaker referred to "credible" coverage, and this was coming from a company professional... LOL

 

[Fisher]

Lost Dollar is having chatty time with a robot.

 

[rmhaire]

Lost Dollar is having chatty time with a robot.

Can't wait until robot boy brings up dental.

LD will wear his ass out.