If you were without Part D or creditable drug coverage for more than 63 days while eligible for Medicare, you may face a Part D late enrollment penalty (LEP). The purpose of the LEP is to encourage Medicare beneficiaries to maintain adequate drug coverage. The penalty is 1% of the national base beneficiary premium ($34.70 in 2024) for every month you did not have Part D or certain other types of drug coverage while eligible for Part D. This amount is added to your monthly Part D premium.

• TEST

Start Over

Get Help Applying for Medicare Cost-Savings Programs

If you live in New York, the Medicare Rights Center can help you enroll in various Medicare cost-savings programs. Please answer a few questions to see if we can connect you with a trained benefits enrollment counselor.

Do you live in New York? Select an optionYesNo

Great! Let's get the basics.

If your monthly income is below $2355 (or below $3189 if married) you may qualify for several Medicare cost-savings benefit programs. The following information will help us determine which programs you might be eligible for.

What is your marital status? * Please select your marital statusMarriedSingleMarried and living separatelyDivorcedWidowed

What is your average monthly income? * Please include the combined monthly household income of you and your spouse Income examples Common sources of countable income include; gross Social Security benefits, pension, VA benefits, employment income, IRA distributions, etc.

In addition to Medicare, do you have Medicaid? (Optional) Please select your Medicaid statusYesNo

Please provide your contact information so a trained benefits enrollment counselor can be in touch to discuss your eligibility and assist you with the application process

First Name*

Last Name*

Email Address* I would like to receive emails from the Medicare Rights Center.

Phone Number*

Zip* Error

City*

Anti-spam

Contact your local State Health Insurance Assistance Program

Each state offers a SHIP, partly funded by the federal government, to give you free counseling and assistance. A SHIP counselor may be available by phone or in person.

Visit www.shiptacenter.org to find your local SHIP office.

Find Your Local SHIP

Contact your local State Health Insurance Assistance Program

Based on the information you provided, you do not appear to be eligible for Medicare cost-saving programs.

Each state offers a State Health Insurance Assistance Program (SHIP), partly funded by the federal government, to give you free counseling and assistance. A SHIP counselor may be available by phone or in person.

Visit www.shiptacenter.org to find your local SHIP office.

Find Your Local SHIP

You are on your way!

A trained counselor from the Medicare Rights Center will be in touch in the next 3-5 business days to discuss your options.

Click here to learn more about the various Medicare cost-savings programs.

Would you like to create a free Medicare Interactive account? Learn about the benefits of creating an account and register today.

Eliminating the Part D LEP

For most people, you have to pay the LEP as long as you are enrolled in the Medicare prescription drug benefit. There are some exceptions:

• If you receive Extra Help, your penalty will be permanently erased
• If you are under 65 and have Medicare, your LEP will end when you turn 65
• If you qualify for a state pharmaceutical assistance program (SPAP), it may pay your penalty for you

Appealing the LEP

Everyone has the right to file an appeal with C2C Innovative Solutions regarding their LEP determination. C2C Solutions is the company contracted by Medicare to handle these appeals. You can appeal the penalty (if you think you were continuously covered) or its amount (if you think it was calculated incorrectly). You should complete the appeal form you received from your plan, attach any evidence you have, and mail everything to:

C2C Innovative Solutions               Toll free fax: (833) 946-1912
Part D LEP Reconsiderations        Customer Service: 833-919-0198
PO Box 44165 
Jacksonville, FL 32231-4165 

If you don’t have an appeal form from your plan, you can also use this form.

Unfortunately, being unaware of the requirement to have prescription drug coverage is unlikely to be a successful basis for your appeal. However, the following are good reasons to appeal and may result in the elimination or reduction of your penalty:

• You have Extra Help
• You had creditable drug coverage during some or all of the time period in question
  • Call your former plan and ask for a letter proving that you were enrolled in creditable drug coverage. Make sure to attach this letter to your appeal form. Your employer or union may also be able to confirm the fact that you had creditable drug coverage.
• You had non-creditable drug coverage, but your or your spouse’s employer or insurer told you it was creditable or didn’t inform you that it was non-creditable
• You were ineligible for Medicare’s prescription drug plan (e.g., if you were living outside the U.S. or incarcerated)
• You couldn’t enroll into creditable drug coverage because of a serious medical emergency

The appeal deadline is 60 days from the date you received the letter informing you about the penalty. If you miss this deadline, you can write a letter explaining why you had good cause, or a good reason—like serious illness—that prevented you from appealing on time. Attach this letter to your appeal. Once your appeal is submitted, you can expect a determination from C2C Innovative Solutions within 90 days. In the meantime, pay the LEP to your plan along with your premium. If your appeal is successful, your plan has to pay you back for the LEP payments you made while your appeal was pending.