Medicare Part D Late Enrollment Penalty

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By Deana Lemmon, LTCP

Deana Lemmon, LTCP

Prescription drug coverage is an important facet of healthcare in north-central Pennsylvania and in our Nation.  Medicare prescription drug coverage is an optional benefit offered to everyone who has Medicare.

“It is an option that requires serious thought on the part of those who are eligible for Medicare,” says Deana Lemmon, long-term care professional at Sarvey Insurance.

Some people have prescription drug coverage from a current or former employer or from unions that provide them with prescription drug coverage that is considered creditable coverage.

Like most things in life, prescription drug plans offered by employers, unions and other currently creditable entities can and do change over time.

“If you do not have creditable coverage and you decide not to get Medicare drug coverage when you’re first eligible, you’ll likely pay a late enrollment penalty if you join later,” stresses Lemmon.

According to medicare.gov, you may incur a late enrollment penalty for Medicare Part D after your initial eligibility period ends unless you have other creditable prescription drug coverage or you meet certain income and resource limits that qualify you for a program called Extra Help.

“Before you make a decision to change your prescription drug coverage, learn how your current prescription drug coverage works,” states Lemmon.

Individuals may have drug coverage from an employer, union, the Department of Veterans Affairs or other creditable entities.

Lemmon continues, “Research is the key to making informed decisions about any healthcare decision – no two individuals are alike, and there are no one-size-fits-all solutions.”

So, what is this late enrollment penalty or LEP?

According to medicare.gov, a person enrolled in a Medicare drug plan may owe a late enrollment penalty if he or she goes without Part D or other creditable prescription drug coverage for any continuous period of 63 days or more after the end of his or her Initial Enrollment Period for Part D coverage.

“You can avoid a late enrollment penalty by maintaining creditable coverage,” states Lemmon. “If you decide to change from your current drug plan to another option, you need to make certain that your transition is a timely one, without any lapse in coverage if possible.”

Annually, those entities beyond Medicare Part D who provide prescription drug coverage produce and mail notifications regarding the extent of their coverage to those insured by their plan.

Lemmon adds, “Most plans that offer prescription drug coverage, like plans from employers and unions, must send their members an annual notice explaining how their prescription drug coverage compares to Medicare Part D – and if it’s considered creditable.”

The good news is that those eligible for Medicare Part D have a choice regarding their prescription drug coverage.  The late enrollment penalty exists to encourage individuals to be responsible and diligent in their choices regarding prescription drug coverage.

Lemmon stresses, “The choice that is best – is the choice that is best for you and for helping you maintain your quality of life.”

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