UNITED STATES—Hello Toni: I retired in April and had a telemarketing agent help me find a Medicare Supplement which began May 1, 2022. No one told me that I had a specific amount of time to enroll in my Medicare Part D plan. I have a serious health issue with Crohn’s disease and should have enrolled at that time for Medicare Part D.
When I enrolled this September for a new Medicare Part D plan, I was denied because did I not apply on time. I take Stelara which is over $2,000 a month that I now must pay on my own.
I am 70 years old and was informed that the penalty for not enrolling in a Medicare Part D prescription drug plan will be $.3337 X 60 months, since my Medicare Part A began 5 years ago at 65. I cannot believe that I must pay an extra $20.02 per month as a Part D “penalty.”
Please explain this ridiculous Medicare Part D rule and when I can begin my plan. I have not purchased my Stelara since I left my employer’s health plan. Thank You, Sydney from Atlanta, GA.
Sydney: Good News!! You can enroll in your Medicare Part D plan that covers your expensive Stelara and other prescriptions that you are currently taking during Medicare’s Annual Enrollment period from October 15-December 7. Your effective date will be January 1, 2023, and you can purchase your Stelara on New Year’s Day, if your pharmacy is open.
Chapter 5 of the Toni Says® Medicare Survival Guide Advanced edition, explains Medicare Part D, how to avoid Part D penalties, and the famous “Donut Hole.”
Once you are past 65 and leaving creditable employer’s group coverage with a prescription drug plan, Medicare gives you only 63 days, not 90 days, not 8 months, but under 63 days to enroll in Medicare Part D or a Medicare Advantage plan with prescription drug coverage.
Your late enrollment period (LEP) did not begin from the day you left your company health plan, nor from your Medicare Part B start date, BUT from the month your Medicare Part A began.
The LEP (late enrollment period) penalty for Medicare Part D can be because:
- You waited past 63 days without creditable prescription drug coverage upon leaving company benefits and you are older than 65 year and 90 days. Readers: Do not wait past 63 days to get Medicare Part D upon leaving company health insurance!
- Your company prescription drug benefits (not health insurance) were not “creditable” as Medicare declares.
- You never enrolled in Medicare Part D at the time you enrolled in Medicare Part A and Part B when you turned 65, and now want to enroll.
Sydney, you were denied Medicare Part D prescription coverage because you met Medicare’s LEP (late enrollment penalty) rule and will receive a Part D penalty when you enroll during Medicare’s Annual Enrollment period; a penalty which lasts a lifetime.
Americans retiring after 65, who are leaving employer’s health plans and applying for Medicare Parts A and B, must also prove they have “creditable coverage” when applying for a Medicare Part D prescription drug plan. This is a Medicare rule.
Is the maze of Medicare confusing you? Listen to Toni’s new Medicare Moments podcasts discussing Medicare issues at www.seniorresource.com/medicare-moments.
Contact the Toni Says® Medicare team at 832-519-8664. Toni King’s Medicare Survival Guide® Advanced edition is available at www.tonisays.com.
Confused About Medicare Zoom Webinar on Wednesday, November 16 at 4-6 p.m. CST. Visit www.ToniSays.com for the Zoom enrollment link.