Use Amplicare's Late Enrollment Calculator:

What is it?

The late enrollment penalty is an amount added to your Medicare Part D premium every month. 

A patient may owe a late enrollment penalty if, at any time after the initial enrollment period is over, there is a period of 63 days or more in a row where he or she doesn't have Part D or other "creditable" prescription drug coverage. 

The initial enrollment period lasts for 7 months, 3 months before and after their 65th birthday (and the month of their birthday). "Creditable" drug coverage can be from an employer or union, a state assistance program, VA benefits, etc. as long as it's expected to pay at least as much as Medicare's standard prescription drug coverage. If a patient gets Extra Help, they don't pay the late enrollment penalty.

How much is the Part D penalty?

The cost of the late enrollment penalty depends on how long the beneficiary went without creditable prescription drug coverage.  

The late enrollment penalty is calculated by multiplying 1% of the "national base beneficiary premium" ($33.19 in 2019) times the number of full, uncovered months the patient didn't join a Medicare Prescription Drug Plan after their initial enrollment period (and went without other creditable prescription drug coverage). The final amount is rounded to the nearest dime and added to their monthly premium.

1% x $33.19 x #of months of without coverage

*The national base beneficiary premium may increase each year, so the penalty amount may also increase each year.

Amplicare does not include your patient's penalty when calculating out-of-pocket costs per plan. However, you can calculate the patient's monthly penalty using our Late Enrollment Calculator above. 

After your patient joins a Medicare drug plan, the plan will tell them if they owe a penalty, and what their premium will be. The beneficiary may have to pay this penalty for as long as they have a Medicare drug plan--usually the rest of their lives 😬!  That's why we suggest you check your Newly Eligible patients report every month, so you can prevent your patient's from incurring this fee. 

If your patient had to pay a Part D late enrollment penalty before they turned 65, the penalty will be waived once they reach 65. 

What's Next?

Reach out to your Newly Eligible patients to make sure your patients enroll in a plan on time by reading this article here!

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