What kind of penalty if we don't sign up for Medicare Part D?

[Paula Sims]

My husband is on my insurance and will be as long as I work (which I plan on for 15 years). We heard we get "penalized for life" if we don't sign up for Medicare Part D NOW. Why? How much is the penalty?

I have great insurance as it is and will keep him on it as long as we're married (which hopefully is a long long time). With Medicare Part D premiums being $100/month or more, why should we sign up for it if we don't need it now?

Thanks

Paula

[Sherman A1]

1. I would check

Medicare.gov

[leftieNanner]

2. I'm not sure what the penalty is

But our Part D premiums are less than $50 per month. They actually went down this year - maybe because we don't have a lot of prescriptions.

[pangaia]

3. Here ya go

Medicare, not the plan, calculates the late enrollment penalty when a person subject to
the penalty first joins a Medicare drug plan. The late enrollment penalty amount typically
is 1% of the national base beneficiary premium (also called “base beneficiary premium”)
for each full, uncovered month that the person didn’t have Part D or creditable coverage.
The national base beneficiary premium for 2019 is $33.19. The monthly penalty is rounded
to the nearest $0.10 and added to the monthly Part D premium.

https://www.cms.gov/Outreach-and-Education/Outreach/Partnerships/downloads/11222-P.pdf

[Ms. Toad]

8. The key thing for the OP is "creditable coverage"

Any standard (i.e. ACA compliant) insurance plan generally satisfies this requirement.

The reason you should sign up (if you don't have creditable coverage) is the same reasoning that requires everyone to have health insurance in the first place. If the plans cover only the most costly people, they will be unaffordable - just as the health care plans were before the ACA for those of us who are uninsurable.

But - the creditable coverage makes it fair to people who aren't avoiding the cost of insurance (just obtaining it from somewhere else while they - or a spouse - are still working.)

[BumRushDaShow]

4. Medicare Part D is the prescription drug coverage

where some kind of "eligible" prescription drug coverage is mandatory or there is a penalty. If your current insurance has an acceptable prescription drug coverage already included, than you won't need Medicare Part D. I think there are bigger penalties if you are eligible for regular Medicare (A/B) and don't sign up for it at the correct time.

[Cattledog]

5. If you have private insurance coverage just keep your records and you won't pay a penalty.

https://www.medicare.gov/drug-coverage-part-d/costs-for-medicare-drug-coverage/part-d-late-enrollment-penalty/3-ways-to-avoid-the-part-d-late-enrollment-penalty

3 ways to avoid the Part D late enrollment penalty

1. Join a Medicare drug plan when you're first eligible.

You won't have to pay a Part D late enrollment penalty, even if you've never had prescription drug coverage before.

2. Don't go 63 days or more in a row without Medicare prescription drug coverage or other creditable drug coverage.

Creditable prescription drug coverage could include drug coverage from a current or former employer or union, TRICARE, Indian Health Service, the Department of Veterans Affairs, CHAMPVA, or health insurance coverage. Your prescription drug plan must tell you each year if your drug coverage is creditable coverage. They may send you this information in a letter, or draw your attention to it in a newsletter or other piece of correspondence. Keep this information because you may need it if you join a Medicare drug plan later and want to avoid the Part D late enrollment penalty.

3. Keep records showing when you had creditable drug coverage, and tell your plan about it.

When you join a Medicare drug plan, the plan will check to see if you had creditable drug coverage for 63 days or more in a row. If the plan believes you didn't, it will send you a letter with a form asking about any drug coverage you had. To avoid a Part D penalty, complete the form and return it to your drug plan by the deadline in the letter. If you don't tell the plan about your creditable drug coverage, you may have to pay a Medicare Part D late enrollment penalty.

[Lefta Dissenter]

6. Not quite there yet,

But I’ve sure been appreciating the recent conversations about Medicare and associated issues.

Thanks DU!

[LakeArenal]

7. Are you talking the supplements or do you mean what they take from SS for Medicare?

You don’t have to buy C or D. But you’ll be responsible for about 20% of your bills because Medicare only pays for about 80%.

If you mean the Medicare deduction, the penalty is pretty big. Like twice as much.

I’m trying to live in a foreign country where there is no place Medicare will cover anything. So we continue to have the deduction because if we opt out, for every year we live out of the country, we will lose 10% of our Medicare coverage if we try to opt back in. So if one of us dies and the other wants to return home after five years we will lose 50% of the benefit when we want back in. So, we might as well stay here forever. It’s really crazy.
Why do they penalize you for not using the benefit.

[TheBlackAdder]

9. My Dr. neighbor said a patient didn't sign for the prescription plan, and was fined $4,000.

[catrose]

10. The answer, of course, is IT DEPENDS

Here's the Medicare link:
https://www.medicare.gov/drug-coverage-part-d/costs-for-medicare-drug-coverage/part-d-late-enrollment-penalty

As I understand it, yes, the penalty is for life, but these things may help you:
1. Maybe your employer's insurance counts as "creditable prescription drug coverage." It's flyover help on the web page, so I couldn't copy it, but the gist is that if you have other insurance that pays for drugs like (or better than) Medicare would, you won't be penalized. You might check to see what kind of documentation you'd need to prove that.

2. If you get Extra Help, you're not penalized.

3. Some Medicare Advantage plans have drug coverage rolled in, so it wouldn't be an extra expense to have drug coverage. Many Advantage plans have no extra premium beyond the $130ish that Medicare would costs. The downside is that you get to deal the same old horrible insurance companies that you've always dealt with.

4. In my area, I found 4 Part D plans under $15/month and only 1 over $100.

YMMV, but I've found the Medicare website more helpful than so-called "Medicare counselors," who have not always been accurate or acting in my best interests, especially if their goal was to sell me their plans. But there is a Medicare page that lists possible sources of information, including 1-800-MEDICARE:
https://www.medicare.gov/Contacts/

[Indykatie]

11. Your Medicare Eligible Husband is Not Required to Sign Up for Medicare B/D Until He Loses Coverage

under your insurance as a dependent on your group plan via your Employer. Your Employer should issue a certificate of creditable coverage each year or as needed. This allows him to sign up for Medicare without any late enrollment penalty. There are Plan D plans that he can select that cost $0 or very little assuming he doesn't have high retirement income. You can verify this information at the Medicare.gov website.

[Blue_true]

12. Call Medicare. My brother had to once, he got someone in about 1 minute.

He got all his questions answered.

[zipplewrath]

13. Wife and I were in the exact situation

She's twelve years older than I. I kept her on my insurance from work for more than 6 years after she turned 65. We checked each year, but because my insurance "qualified", she was not penalized. You do have to sign up for Medicare part A, but that costs nothing and your employer may require it. We finally switched to Medicare in anticipation of my retirement. Dot all the "i's" and "t's" but I strongly suspect you're fine.

[KentuckyWoman]

14. Every year you get a form 1095-C or 1095-B - keep it forever

Your employer should be sending you a form every tax season showing your husband covered on your plan. That form is your ticket to avoiding the penalties. Just be sure once he's off your plan (if ever) that you don't allow a gap in coverage.

if they try to hit him with a penalty when / if he signs up for part D... you can send in copies of the forms showing coverage.

This satisfies the rules as written today.

https://www.medicare.gov/drug-coverage-part-d/costs-for-medicare-drug-coverage/part-d-late-enrollment-penalty

You may owe a late enrollment penalty if, for any continuous period of 63 days or more after your Initial Enrollment Period is over, you go without one of these:

A Medicare Prescription Drug Plan (Part D)
A Medicare Advantage Plan (Part C) (like an HMO or PPO) or another Medicare health plan that offers Medicare prescription drug coverage
Creditable prescription drug coverage

[Timewas]

15. Penalty

The Medicare Part D penalty is based on the number of months you went without PDP coverage. For each month without coverage, you will pay an additional premium of 1 percent of the current “national base beneficiary premium.” For 2020, the beneficiary premium is $30. This is not a one-time penalty.

[PoindexterOglethorpe]

16. There are also lots of Advantage plans

that require no extra money and cover all sorts of wonderful things.

Just do a bit more research.

Also, if I recall correctly, if you are still currently covered under an employee health plan, you can postpone part D or an Advantage Plan until no longer covered that way. The clock starts ticking only when you quite that job.

I'm sure you can find a ton of information on the internet.