Late Enrollment Penalty. If any Members are subject to the Medicare Part D late enrollment penalty, Monthly Premiums for those members will increase to include the amount of the penalty.
Late Enrollment Penalty. If any Members are subject to the Medicare Part D late enrollment penalty, Premiums for those Members will increase to include the amount of the penalty. January 1 – December 31, 2024 Evidence of Coverage Your Medicare Health Benefits and Services and Prescription Drug Coverage as a Member of Xxxxxx Permanente Medicare Advantage Group Plan (HMO) Chapter 1 — Getting started as a member 29
Late Enrollment Penalty. You may pay a financial penalty if you did not enroll in a plan offering Medicare Part D drug coverage when you first became eligible for this drug coverage or you experienced a continuous period of 63 days or more when you didn’t keep your prescription drug coverage. The amount of the penalty depends on how long you waited before you enrolled in drug coverage after you became eligible or how many months after 63 days you went without drug coverage. The penalty is added to your premium. When you first enroll, we let you know the amount of the penalty. Medicare determines the amount of the penalty. Here is how it works: ● First count the number of full months that you delayed enrolling in a Medicare drug plan, after you were eligible to enroll. Or count the number of full months in which you did not have credible prescription drug coverage, if the break in coverage was 63 days or more. The penalty is 1% for every month that you didn’t have creditable coverage. For our example, let’s say it is 14 months without coverage, which will be 14%. ● Then Medicare determines the amount of the average monthly premium for Medicare drug plans in the nation from the previous year. ● You multiply together the two numbers to get your monthly penalty and round it to the nearest 10 cents There are three important things to note about this monthly premium penalty: ● First, the penalty may change each year, because the average monthly premium can change each year. If the national average premium (as determined by Medicare) increases, your penalty will increase. ● Second, you will continue to pay a penalty every month for as long as you are enrolled in a plan that has Medicare Part D drug benefits. ● Third, if you are under 65 and currently receiving Medicare benefits, the late enrollment penalty will reset when you turn 65. After age 65, your late enrollment penalty will be based only on the months that you don’t have coverage after your initial enrollment period for Medicare. If you are eligible for Medicare and are under 65, any late enrollment penalty you are paying will be eliminated when you attain age 65. After age 65, your late enrollment penalty is based only on the months you do not have coverage after your Age 65 Initial Enrollment Period. Even if you have delayed enrolling in a plan offering Medicare Part D coverage when you were first eligible, sometimes you do not have to pay the late enrollment penalty. You will not have to pay a premium penalty for late enrollme...
Late Enrollment Penalty. Plan Beneficiary Premium for the Medicare Advantage with Prescription drug plan may include any late enrollment penalties as determined applicable by CMS. The late enrollment penalty (“LEP”) is based on the combination of a percentage of the national average Part D bid amount set by CMS and the number of months a beneficiary has not enrolled in a Medicare Part D plan, when eligible or a Member does not have creditable coverage (coverage containing a prescription drug benefit that is equivalent to Medicare Part D). The LEP is communicated to United by CMS upon confirmation of Member enrollment by CMS. In the event Member is assessed a LEP by CMS, United will bill the LEP directly to Group. Otherwise, upon Group’s written authorization, United will bill the LEP directly to Member. In the case where United bills Member directly for Plan Beneficiary Premium, United will bill the LEP directly to the applicable Member.
