UNITED STATES—Hello Toni: I made a terrible mistake last April when I was no longer being covered by my employer group health plan due to retiring. I had a telemarketing agent help me find a Medicare Supplement which began April 1, 2020. 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 Crones disease and have had a liver transplant in the past and should have enrolled at that time for my Medicare Part D.
When I enrolled in July for a new Medicare Part D plan, I was denied because I did not apply on time. I take Stelara which is over $2,000 a month that I now must pay on my own. I now am 70 years old and have been told that my Part D penalty for not enrolling in Medicare Part D will be $.3274 X 60 months since my Part A began 5 years ago. I cannot believe that I must pay an extra $19.64 per month as a Part D penalty.
Please explain this ridiculous Medicare Part D penalty. I have not purchased my Stelara in the last few months. Thank You, Sydney from Atlanta, GA.
Sydney: You are aware you waited too long to apply for a Medicare Part D plan. Once you are past 65 and/or leaving creditable coverage, Medicare gives you 63 not 70 or 90 days to apply for a Medicare Part D or Medicare Advantage plan with prescription drug coverage. Not needing to order your prescriptions does not refrain from receiving Part D penalties.
Your late enrollment period (LEP) does not begin from the day you lose or leave your company health plan, BUT from the month you turned 65 or began your Medicare and is based on when Medicare Part A begins not Part B.
This LEP (late enrollment period) penalty can be because:
1) You waited past 63 days without creditable prescription drug coverage when you are leaving company benefits and you are older than 65 years old and 90 days. Don’t wait past 63 days to get Part D when leaving company health plans.
2) Your company prescription drug benefits (not health benefits) are not creditable as Medicare declares.
3) You simply never enrolled in Medicare Part D when you were first eligible and want to enroll.
Your company prescription drug benefits met Medicare’s “creditable coverage” rule, but you waited past the 63-day window to apply. Sydney, you have been denied Part D prescription coverage because you did not follow Medicare’s LEP (late enrollment penalty) rule and are receiving a Part D penalty.
You must wait until the next Medicare Annual Enrollment period from October 15-December 7 to enroll in a Medicare Part D prescription drug plan with your effective date to be January 1, 2021.
Americans retiring after 65, that are leaving company health plans and applying for Medicare Parts A and B must also prove they have “creditable coverage” when applying for Medicare Part D prescription drug plan.
The Medicare & You handbook states: “Creditable prescription drug coverage could include drug coverage from a current or former employer or union, TRICARE, Indian Health Service, the VA or health insurance coverage.”
Is the maze of Medicare confusing you? Call the Toni Says® Medicare hotline at 832-519-8664 or visit the Medicare Annual Enrollment Toni Says® webinars which explain what Medicare is and how to properly find your Medicare Part D plan at www.tonisays.com.
Toni King, author of the Medicare Survival Guide® is giving a $5 discount on the Medicare Survival Guide® Advanced book.