UNITED STATES—Hello Toni: I made a terrible mistake last April when I was no longer 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, 2021. 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 my Medicare Part D.
When I enrolled in July 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 now am 70 years old and was informed that my Part D penalty for not enrolling in a Medicare Part D prescription drug plan will be $.3306 X 60 months since my Part A began 5 years ago. I cannot believe that I must pay an extra $19.84 per month as a Part D penalty.
Please explain this ridiculous Medicare Part D penalty and please tell me I can enroll during this Medicare Annual Enrollment period. I have not purchased my Stelara in the last few months. 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, 2022, and you can go purchase your Stelara on New Year’s Day, if your pharmacy is open. If not, then January 2.
You are aware that 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.
Your late enrollment period (LEP) did not begin from the day you left your company health plan, BUT from the month your Medicare Part A began not when your Medicare Part B began.
The LEP (late enrollment period) penalty for Medicare Part D 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.
Sydney, you were denied Medicare Part D prescription coverage because you did not follow Medicare’s LEP (late enrollment penalty) rule and will receive a Part D penalty when you enroll during Medicare’s Annual Enrollment period.
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 a Medicare Part D prescription drug plan.
In Chapter 5 of the Toni Says® Medicare Survival Guide Advanced edition, it explains Medicare Part D and how to avoid the Part D penalties and what is the famous “Donut Hole.”
Is the maze of Medicare confusing you? Call the Toni Says® Medicare hotline at 832-519-8664 or view the Toni Says® Medicare Annual Enrollment Zoom webinar on Wednesday, November 17 at 4 p.m. which explains the ABC and D of Medicare at www.tonisays.com.
Medicare Open Enrollment Special: $10 discount to the Toni Says® readers on the 2021Medicare Survival Guide® Advanced book at www.tonisays.com.