Medicare Part D Late Enrollment Penalty

Aug 5, 2016

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  1. somarco
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    somarco That Medicare Expert Guy

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    You may owe a late enrollment penalty if you go without a Medicare Prescription Drug Plan (Part D), or without a Medicare Advantage Plan (Part C) (like an HMO or PPO) or other Medicare health plan that offers Medicare prescription drug coverage, or without creditable prescription drug coverage for any continuous period of 63 days or more after your Initial Enrollment Period is over.

    https://www.medicare.gov/part-d/costs/penalty/part-d-late-enrollment-penalty.html

    Most of my clients have prior creditable coverage. Took an app today on someone who hasn't had health insurance for almost a year.

    If reading the above correctly, his initial enrollment starts 10/1 and ends the last of March. If he wanted, he can wait until end of May of next year before enrolling in a PDP without penalty.

    Correct?
     
    somarco, Aug 5, 2016
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  2. TwoCents
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    TwoCents Guru

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    Not exactly since it looks like you took a swing and missed on figuring out the IEP. It should be 10/1/16 to 4/30/17. I'm assuming he turns 65 and this is a standard age-in situation where he's starting all Medicare parts 1/1/17. So yes, he would have until 6/30/17 before he'd have to sweat the LEP, but beyond 4/30, what election would you use to enroll into a Part D plan?
     
  3. vic120
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    vic120 Guru

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    In theory but don't forget He needs to qualify for enrollment period to purchases the plan. And it is not Med Supp initial enrollment period it is speaking of But MA/PDP initial Enrollment period
     
    vic120, Aug 5, 2016
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  4. WCMason
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    WCMason Guru

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    That is probably not correct but it depends on his circumstances. The only way he would get the additional two months is if he has eligibility for a special election, such as leaving employer coverage. It sounds like your client does not have that so the deadline day would be the last day of his IEP. This would be 4/30 if he turned 65 any day in January except the first.
     
    WCMason, Aug 5, 2016
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  5. somarco
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    somarco That Medicare Expert Guy

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    Turns 65 mid October. Going on A, B and Medigap 10/1. Has enough med's warehoused to take him through end of the year. Wants to skip the short year (Oct - Dec) and just sign up for PDP before end of year and start 1/1/17.

    So other than not using enough fingers (or too many) he should be good to go without triggering a penalty
     
    somarco, Aug 5, 2016
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  6. Matthew King
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    Yes, you shouldn't have to worry about the LEP at all if he is looking to start 1/1/17.
     
  7. kgmom219
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    kgmom219 What's Next?

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    Should be good to go? Yes.

    100%, I'll stake my reputation on it? NOT A CHANCE.

    "Mr. So-So, I am 99% sure this will fine. However, its the government. There are no guarantees. Are you sure you don't want to spend the $60, just to make sure you don't incur the penalty (not to mention if you get sick and the doc needs to put you on more than one antibiotic)."
     
  8. Matthew King
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    Aren't all things with government involved 99.9% sure? lol :D
     
  9. WCMason
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    WCMason Guru

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    He can enroll as late as 1/31/17 to avoid a penalty. In my Salesforce CRM I have a drop down menu with categories for drug plan status if they did not enroll at same time as med sup, such as waiting to confirm rx list with Dr., waiting for AB enrollment, waiting for last month of IEP, etc. Many of my clients taking no drugs or subject to IRMAA will wait until the last month of IEP. I call them the first week of that final month to get them enrolled. Called all my May T65 Rx delayers this week letting them know we need to do it now, as Aug is their last IEP month. They all know they can call me sooner to get enrolled to start the first day of the next month. It's worked well for the four years I've been med sup focused.
     
    WCMason, Aug 5, 2016
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  10. somarco
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    somarco That Medicare Expert Guy

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    I am 99.99% certain he will probably go for an effective date around the first of January. So that's a definite maybe.
     
    somarco, Aug 5, 2016
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