Webinar: Preparing for Medicare Eligibility & Understanding Your Options
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Medicare Late Enrollment Penalty (LEP)
The Late Enrollment Penalty (LEP) applies to both standalone Medicare Part D prescription drug plans (PDPs) and Medicare Advantage plans that include prescription drug coverage (MAPDs). If you don't have creditable prescription drug coverage for 63 days or more after your Initial Enrollment Period (IEP), you may incur this penalty.
Did you get a notice from your Prescription Drug Plan (PDP) or Medicare Advantage Plan (MAPD) saying your monthly Part D premium is going up because of a penalty? This is called the Late Enrollment Penalty (LEP). It's 1% of the national base premium ($36.78 in 2025) for each month you didn't have Part D or other drug coverage when you were eligible. This penalty is added to your monthly premium.
Here's what you should do:
Check with your former plan to determine if your coverage was creditable. Typically, plans or your employers sent you and annual notice letting you know their plan is creditable. We can check the Medicare Advantage and Prescription Drug System (MARx) to see what Medicare's record of your coverage history (Post 65) looks like.
NOTE:
Declaration of Prior Drug Coverage:
Use this form to prove you had creditable prescription drug coverage (coverage as good as Medicare's) during a period when you were not enrolled in a Medicare Part D plan. This can help you avoid or reduce a late enrollment penalty (LEP) if you can show that you had other qualifying coverage.
Part D Enrollment Penalty (LEP) Reconsideration Request:
Use this form if you believe the late enrollment penalty (LEP) imposed on you is incorrect. This could be because you had creditable coverage but didn't receive a notice, or you were not eligible to enroll in a Medicare Part D plan during the period in question. This form allows you to appeal the decision and provide evidence to support your case.