Penalty Calculator

The late enrollment penalty is calculated by multiplying 1% of the "national base beneficiary premium" ($35.02 in 2018) times the number of full, uncovered months your patient didn't have Part D or other creditable coverage (but were eligible). The penalty amount is rounded to the nearest $.10 and added to their monthly Part D premium.

How much is the Part D late enrollment fee?
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Estimated penalty calculated for 0 months without coverage

$0.00

per month

In addition to the monthly premium

Penalty Calculator

The late enrollment penalty is calculated by multiplying 1% of the "national base beneficiary premium" ($35.02 in 2018) times the number of full, uncovered months your patient didn't have Part D or other creditable coverage (but were eligible). The penalty amount is rounded to the nearest $.10 and added to their monthly Part D premium.

Who is affected?

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

  • A Medicare Prescription Drug Plan (Part D)
  • A Medicare Advantage Plan (Part C) like an HMO or PPO with drug coverage
  • Creditable prescription drug coverage through an employer or union
  • Dual Eligible/ Extra Help recipients are exempt from paying the penalty

When does your patient find out their penalty amount?

When they enroll in a Medicare Part D plan, the plan will tell them if they owe a penalty and what the total premium, including the penalty, will be. Click here for additional details on the Part D Late Enrollment Penalty, including the process for "reconsideration".

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