Can I Appeal a Part D Late Enrollment Penalty (Lep)?

Emily WhicheloeDear Marci0 Comments

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Shapiso/Shutterstock.com
Dear Marci,
I enrolled in Medicare Parts A and B a few years ago when I turned 65, but I only recently signed up for a Part D plan. Then I received a notice from the plan telling me that my monthly Part D premium payment will go up because I have a late enrollment penalty on top of my regular premium. Is there any way I can get this penalty to go away? Carter (Tupelo, MS)

Dear Carter,

The Part D late enrollment penalty (LEP) is 1% of the national base beneficiary premium ($34.10 this year) for every month you did not have Part D or certain other types of drug coverage while eligible for Part D. This amount is added to your monthly Part D premium.

For example, an individual has a late enrollment penalty if they did not sign up for Medicare Part D when they were first eligible to do so, or if they went more than 63 days without drug coverage that was at least as good as Medicare Part D coverage (this is known as creditable coverage).

It is always your right to appeal an LEP, but your appeal is unlikely to be successful if you appeal because you did not know that you were supposed to have prescription drug coverage.

You can appeal this LEP if you believe that it was assessed by mistake, such as if:

  1. You were covered by creditable drug coverage while eligible for Medicare.
  2. You received inadequate information about whether your drug coverage was creditable.

To appeal, complete the appeal form you received from your plan, attaching any evidence you have. Evidence can be a letter from your employer or former employer stating that you had creditable coverage during the time that you were eligible for Medicare but not enrolled in a Part D plan. Then mail everything to the address on the appeal form. This address should be for MAXIMUS Federal Services, which is the company contracted by Medicare to handle these appeals.

The appeal deadline is 60 days from the date you received the letter informing you of the penalty. You can expect a decision from MAXIMUS within about 90 days. If your appeal is successful, your plan has to pay you back for the LEP payments you made while your appeal was pending.

– Marci

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