Penalties

Right now, Medicare Beneficiaries are in the middle of looking at their Prescription Drug Plans and/or their Medicare Advantage Plans and making sure it still meets their needs.      October 15th until December 7th is the Annual Election Period and the time of year when they can change plans or sign up for one if they never had one.

When a beneficiary first becomes eligible for Medicare, this is called their Initial Enrollment Period or IEP.     This happens on these occasions:

  • Newly eligible for Medicare because of just turning 65.
  • Newly eligible for Medicare because I’m disabled (under 65).
  • I’m already eligible for Medicare because of a disability and I turned 65.

When one of these things happens, you have a seven month window that includes three months prior to the month your turn 65, the month you turn 65, and three months after you turn 65 to sign up for either a Medicare Advantage or Medicare Prescription Drug Plan.     To give you an example, if you were turning 65 in November, you would be able to sign up from August until February.       If you don’t sign up during this period and haven’t had credible prescription drug coverage for more than 63 days in a row, you may owe a late enrollment penaly.

The cost of this penalty will depend on how long you went without credible prescription drug coverage.    The late enrollment penalty is calculated by multiplying 1% of the national based premium for prescription drug coverage ($31.08 in 2012) times the number of full months you were eligible, but didn’t join a prescription drug plan.    The final amount is rounded to the nearest $.10 and added to your monthly premium.    The national base premium may increase each year so the penalty may increase as well.

To make sure you avoid a late enrollment penalty, Balanced Care recommends:

  • Giving us a call at least three months prior to turning 65 so we can go over your options, and give you plenty of time so you are comfortable with your plan.
  • Join a Medicare Prescription Drug Plan when you are first eligible.
  • Don’t go 63 days or more in a row without a Medicare Part D plan or other credible coverage (credible coverage would include a former employer, TRICARE, or Veterans Affairs)
  • Tell both us and your plan about any prior drug coverage you have had.

Balanced Care has unfortunately seen too many people be penalized with regards to Medicare Prescription Drug Coverage and we don’t want to see this happen to you.       We always encourage no obligation consultations and encourage family members to be there with you to support you while you make an important decision regarding your health care.

Terri Trepanier is the Owner of Balanced Care and a licensed insurance broker in New Hampshire and Maine.  Located in Rochester, NH, she specializes in helping individuals and businesses with their Health Insurance, Dental Insurance, Life Insurance, Disability Insurance, Long Term Care Insurance, Medicare Supplemental, Medicare Prescription Drug Plans, Accident, Critical Illness, and Cancer Plans.    Terri knows the importance of insurance products and how they help individuals and families.    She continually strives to give her clients the Peace Of Mind that each of us deserves.

Balanced Care – Providing Balance, Security, and Peace Of Mind

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