Ignoring Medicare Rules Costs Americans MILLIONS in Penalties

Toni,

I need your help! I just discovered that my mother, who’s 67, never enrolled in Medicare Part B or D. She was under the impression that if she didn’t go to the doctor, she didn’t need to pay the premium and could enroll later. 

Unfortunately, she’s just been diagnosed with colon cancer. I called the Social Security Administration to help her enroll in Part B. The agent informed me that she must wait until January 1 to enroll in Medicare Part B. Apparently, my mother has missed her “window of opportunity” since she didn’t enroll when she turned 65 and will receive a penalty when she enrolls. Please advise me on what I can do to help her.

Thanks,
Jeanine from El Paso, TX

Jeanine,

Your mother has an EXTREMELY serious Medicare issue! She’ll have to enroll during Medicare’s General Enrollment Period (GEP). It runs from January 1st to March 31st each year for those who never enrolled in Medicare Parts A and B. Sadly, your mother will receive the famous “Part B penalty” for the rest of her Medicare life.

More on the General Enrollment Period

Let’s discuss the General Enrollment Period more. Now, when you enroll in January, February, or March, your Medicare Part B will begin the first day of the following month. If you wait past March 31 to enroll, your Medicare enrollment will be delayed until January 1st of the next year, and you’ll receive a higher Part B penalty. Unfortunately, the penalty will go back to the month you turned 65. 

Jeanine, when your mother enrolls in Medicare Part B, she’ll receive the Part B penalty, which is a 10% penalty for each 12-month period or year that she failed to enroll. Your mother’s penalty will be 20% (2 years times 10%) for as long as your mother could have had Part B but failed to enroll. The penalty remains in effect for the life of the Medicare beneficiary’s Medicare coverage.

For your mother to enroll in a Medicare Part D plan, she must wait until the next Medicare Annual Enrollment Period (AEP), which is from October 15th through December 7th. The Medicare Part D plan will start on January 1^st. The Medicare Part D penalty is 1% for each year that you could have enrolled in Part D but failed to enroll in Part D from age 65. This penalty, which is based upon the national Part D average premium, also changes as the national Part D average changes. 

More on Medicare Enrollment Periods

• Medicare Initial Enrollment Period (IEP): a 7-month window that begins 3 months before turning 65, the month one turns 65, and 3 months after one turns 65. 
• Special Enrollment Period (SEP): The 8-month window of signing up for Part B without receiving a Part B penalty after turning 65. One must be working full-time with company benefits to avoid the Part B penalty.
• General Enrollment Period (GEP): January 1-March 31 for anyone who has not enrolled in Part B and now can enroll in Medicare Part B beginning the next month. You WILL receive a Medicare Part B penalty if you are past your IEP and do not meet the criteria of the SEP.

The Changes Coming to Medicare in 2024

2024 Medicare Part D Costs Are:

• The initial Deductible is $545.
• The initial Coverage Limit is $5,030 when the “Donut Hole” begins.
• Donut Hole (Coverage Gap) begins once the Medicare beneficiary reaches the Medicare Part D plan’s initial coverage limit of $5,030 and ends when a total of $8,000 is out-of-pocket. The Medicare beneficiary will then be responsible for only 25% of the prescription drug cost while 70% is paid by the brand name/generic drug manufacturer and 5% is paid by the enrolled Medicare Part D plan until the Donut Hole ends when the $8,000 exit point is reached.
• Catastrophic Coverage of $0 out of pocket begins January 1, 2024: when a Medicare recipient enters Catastrophic Coverage. Medicare will pick up all costs of the prescriptions whether brand name or generic and those with a Medicare Part D plan pay $0.

On January 1 of each year, the process starts all over again with a new Medicare Prescription Drug plan and different costs, deductibles, and a new Donut Hole. 

How to Stay Out of The Donut Hole or Not Get In as Soon!

• Visit www.medicare.gov when selecting a Medicare Part D plan, whether it is your first time or changing during Medicare’s Annual Enrollment Period in the fall. This is an accurate way to view the cost of drugs, which Part D Prescription Drug plan meets your needs, and the most cost-effective pharmacy.
•  Talk to your primary care and specialty doctors about which brand-name drugs can be changed to generics.
• Get samples from your doctor.
• Search various prescription drug programs such as GoodRx or Single Care for inexpensive prescription drug costs. HEB, Wal-Mart, Kroger, and Costco also have discount prescription drug plans. To get their discounted price, you only need a prescription from your doctor.
• Contact the Texas A&M Medication Assistance Program at 866/524-1408 for extra help. This organization has saved over 64 million dollars helping people receive expensive brand-name prescriptions at affordable prices when they cannot afford the Part D cost for them.

The Importance of Part D

Remember, with Medicare, what you don’t know WILL hurt you!

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