Toni Says: Enrolled in Medicare Part B…NOW I’m Receiving a Part D Penalty…Why?

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Hello Toni:

Turned 65 in August 2018, continued to work full-time with company benefits, until I was laid off on May 10th and that is when my employer benefits ended. I have enrolled in a Medicare supplement plan G and a Part D prescription drug plan with a September 1st start date because that is when my Medicare Part B starts.

Now my troubles are beginning because I have received a notice from CMS (Medicare) saying they do not have record of me having prescription drug coverage that “met Medicare’s minimum standards from 8/1/2018 when my Medicare Part A started to 9/1/2020 and I am receiving a Part D late enrollment penalty. 

I do not understand why I am receiving a Medicare Part D penalty. I thought applying for Part B keep me from a Medicare penalty. What is the 63-day window that the Part D prescription drug plan is talking about? 

I have been quarantined due to contracting coronavirus and was not able to explore my Medicare options. Is there a way that I can appeal this Part D penalty due to COVID-19 issues? Thank You, Sydney from St. Louis, MO

Sydney:

Generally, when there are Medicare special enrollment problems due to weather issues, Medicare will give extra time for enrollment periods such as Medicare Annual Enrollment in October. My advice to you is to call Medicare at 1/800-633-4227 or the Medicare Part D plan which you have enrolled in and explain that you have been in quarantine due begin exposed to coronavirus. IRS extended the April 15 tax filing date due to COVID-19, so I would ask for an appeal to the penalty due to being unable to take care of your personal Medicare business because of being in quarantined.

Taking the “Request for Employment Information” form to Social Security to avoid the “famous” Medicare Part B penalty informs Medicare that you have had employer benefits since turning 65. The form does NOT inform Medicare that you had “creditable” prescription drug coverage.

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. Your plan must tell you each year if your drug coverage is “creditable coverage”. Keep this information because you may need it when or if you join a Medicare drug plan late.

Creditable drug coverage should “meet or exceed” what Medicare’s Part D plan minimums are for that current year. 

Medicare does not regard discount prescription drug cards or low-cost generics programs such as GoodRX as “creditable coverage”. These types of plans cannot keep you from the Late Enrollment Penalty

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 or is based on when Part A of Medicare begins not Part B. 

This LEP (Late Enrollment Period) penalty can be because:

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. (which technically is what you did, Sydney) Do not wait past 63 days to get Part D when leaving company health plans.

Your company prescription drug benefits (not health benefits) are not “creditable” as Medicare declares.

You simply never enrolled in Medicare Part D when you were first eligible and want to enroll.

Toni King, author of the Medicare Survival Guide® is giving a $5 discount on the Medicare Survival Guide® Advanced book and bundle packages for the Toni Says® newspaper article readers at www.tonisays.com. Email info@tonisays.com for Medicare questions.

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