One of the reasons Caribou stresses the importance of enrollment periods for individuals eligible for Medicare is that if you don’t enroll at the right time, you can be subject to a late enrollment penalty (LEP) fee. This penalty is applied to your monthly premiums for the rest of your life. So timing your Medicare enrollment correctly is very important. If you are receiving Social Security retirement or disability benefits, you will be automatically enrolled in Medicare Parts A (hospital) and B (medical services). Unless you or your spouse is/are continuing to work past 65, you usually* have to actively enroll in Medicare Parts A and B when you become eligible.
* Depending on the size of your employer determines when you become eligible. If your or your spouse’s employer has less than 20 employees, you will generally be required to enroll in Medicare Parts A and B. Your employer coverage functions as your supplemental and drug coverage. This way, you won’t incur late fees when you lose your employer coverage. But if your employer has more than 20 employees, you may have more Medicare enrollment options through your employer.
See below for the LEP fees for each part of Medicare:
If you miss your initial enrollment period for Parts A and B, and don’t have other coverage, you will likely have to pay for all health services out of your own pocket. You won’t be able to enroll until January 1st, which is when the General Enrollment Period is, and your healthcare coverage will start July 1st.
Appealing LEP Fees:
If you disagree with an LEP fee, you have the right to request a reconsideration for your prescription drug coverage with your Part D or Medicare Advantage plan or appeal with the Social Security Administration for a Part B LEP. Reconsiderations or appeals are typically considered when you have proof of coverage during what was considered a lapse in coverage by your plan.
Learn More:
How Do I Defer Medicare Coverage? | Healthline
Deciding Whether to Enroll in Medicare Part A and Part B When You Turn 65 | CMS.gov
Last Updated September 11th, 2024