Why am I getting a Medicare Part D late enrollment penalty? – The Observer

Hello Tony:

I received a notice from CMS (Medicare) that they have no record of my prescription drug coverage that “met Medicare minimum standards as of 8/1/2019 when I applied for Medicare Part A after have reached the age of 65 on 6/1/2022, and I can receive a Part D Late Registration Penalty. I had enrolled in Medicare Part B after losing my job due to a recent layoff.

I thought the Part B application with the Medicare form signed by my HR department informed Medicare that I had been covered for employer benefits, including prescription drug coverage. What do I do? I don’t understand any of this! Jessie from San Diego, CA


Americans retiring or laid off after age 65 with employer group benefits applying for Medicare Parts A and B must show proof of “honorable” prescription drug coverage when applying for their new Medicare Part D.

Submitting the “Request for Employment Information” form to Social Security to avoid the “notorious” Medicare Part B penalty informs Medicare that you have received benefits since age 65. The form does not inform Medicare that you have “creditable” coverage for prescription drugs.

The letter you received from the new Medicare Part D prescription drug plan you enrolled in explains what you need to do to tell Medicare about the prescription drug coverage you had by calling an 800 number or with a form outlining the type of coverage you had. you can mail back to the Medicare Part D plan you enrolled in.

Because America is overloaded with marketing materials when enrolling in Medicare, many do not open important mail and do not understand the importance of informing the specific Medicare Part D plan regarding the type of drug coverage on prescription received upon departure from employer benefits.

The Medicare and you The handbook states, “Creditable prescription drug coverage may include drug coverage from a current or former employer or union, TRICARE, Indian Health Service, VA, or insurance coverage. Health Insurance. Your plan must tell you each year if your drug coverage is “eligible coverage”. This information may be sent to you in a letter or included in a scheme newsletter. Save this information because you may need it if you are late enrolling in a Medicare drug plan.

The manual does NOT indicate what qualifying coverage is. Qualifying drug coverage must “meet or exceed” Medicare Part D plan minimums for the current year.

Confusing, I know… Medicare does not consider discount prescription drug cards or low-cost generic programs as “creditable coverage.” These types of plans cannot save you from the late registration penalty.

Your Late Enrollment Period (LEP) does not start from the day you lose or leave your company health plan, BUT from the month your Medicare Part A starts and not Part B.

This LEP (Late Enrollment Period) penalty may be due to:

  • You waited past 63 days without valid prescription drug coverage when you leave company benefits and are over 65 years and 90 days. Don’t wait more than 63 days to get Part D when you leave company health plans. If your Medicare LEP letter needs to be reviewed by a Toni Says® Medicare consultant, call 832/519-8664 or email [email protected]
  • Your company’s prescription drug benefits (not health benefits) are not creditable as Medicare states.
  • You simply never enrolled in Medicare Part D when you first qualified and want to enroll.

Last week, a Toni Says® Medicare client called to ask a Toni Says® Medicare consultant for the letter he had received in May that had never been opened and related to his 63-day look-back period.

Sign up for the Toni Says® Medicare newsletter explaining Medicare rules on

www.tonisays.com better under the Medicare LEP penalty.

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