Not following Medicare Part D rule can result in costly penalty

Dear Toni: I read your article about how ignoring Medicare rules is costing Americans millions, and I believe I have made a mistake because I have not enrolled in a Medicare Part D prescription drug plan.

I retired in August and had a telemarketing agent help me find a Medicare supplement, which began Sept. 1. No one told me that I had a specific amount of time to enroll in my Medicare Part D plan. Currently, my prescriptions are generic, and I use GoodRx to receive a discount.

When I enrolled on Dec. 15 for a new Medicare Part D plan, I was denied because I did not apply on time.

I am 70 and my Part D will begin next year when I’m 71. Medicare informed me that the Part D penalty will be $0.3470 times 72 months since my Medicare Part A began six years ago at 65. I cannot believe that I must pay an extra $25 per month as a Part D penalty.

Please explain this ridiculous Medicare Part D rule and when I can begin my plan. — Samuel from Chattanooga, Tennessee

Dear Samuel: Because you missed the Medicare annual enrollment period for 2024, you will have to wait until the next one, from Oct. 15 to Dec. 7, to enroll in a Part D plan. Your effective date will be Jan. 1, 2025.

The good news is that you are currently taking generics and can use GoodRx (which is not something that Medicare deems a “creditable” prescription drug plan) until you can enroll in Medicare Part D.

Once you are past 65 and leaving a creditable employer’s group coverage with a prescription drug plan, Medicare gives you only 63 days to enroll in Part D or an Advantage plan with prescription drug coverage.

Your late-enrollment period did not begin the day you left your company health plan, nor from your Medicare Part B start date. It began the month your Medicare Part A began.

The late-enrollment penalty for Medicare Part D can be charged to you because:

■ You waited past 63 days without creditable prescription drug coverage upon leaving company benefits and you are older than 65 years and 90 days.

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

■ You never enrolled in Medicare Part D when you enrolled in Parts A and B when you turned 65, and now want to enroll.

Samuel, you will receive the Part D penalty when you enroll — a penalty that lasts a lifetime.

Americans retiring after 65 who are leaving their employer’s health plans and applying for Medicare Parts A and B must also prove they have “creditable coverage” when applying for a Part D prescription drug plan. Don’t delay your Part D enrollment.

Toni King is an author and columnist on Medicare and health insurance issues. If you have a Medicare question, email info@tonisays.com or call 832-519-8664.