Hi all,
I signed my grandma (84) up for a Medicare Part D plan during the open enrollment period. She’d never had one before because she said she didn’t need it but this coming year the doctor wants to put her on an incredibly expensive cancer medication so I convinced her to sign up.
She’s always had the PO box we use (same county but different zip code from our home address) on file as her SSA address but the part D application asked for a permanent address and wouldn’t let me change the zip code without doing so in her online social security account, which she’d never set up. To sign up for an account they had to physically mail us an activation code and it wouldn’t have arrived before the enrollment period ended so I took a gamble and applied with our mailing address anyway because I thought I’d been able to sign up for my own part D plan using the PO box a few years ago.
A couple weeks later, I ended up signing up for the same part D plan as I’d selected for her at the last minute because the price of my existing one was going up. I received a letter asking me to call and update my permanent address with them so I decided to update hers with them on the same call. Only, when they looked up her account it showed the application was rejected because they said tried to contact her in November and she never responded.
My grandma says she never got a letter or email from them about this, and now that the open enrollment period is over they couldn’t enroll her because she didn’t qualify for any of the special enrollment periods. It didn’t seem to matter that the letter informing her of the info they needed may very well have been lost in the mail.
She has an existing Medicare Supplement Plan with New Era that doesn’t include RX coverage so I did leave her insurance agent there a message to see if we could just change her to one of their plans that does include it but I’m not even sure if they offer them.
Is there nothing else we can do besides wait til next year? We’d be totally fine paying a late enrollment fee but from what I can tell that’s only an option if you recently turned 65?
I’ve been trying to Google if we could just pay for a non-Medicare affiliated prescription drug plan for 2025 and nothing useful has come up. I know Medicare is the gold standard but at this point we’d take anything that would cover the very expensive new medication she’s meant to start next month.
If you missed the Medicare Part D enrollment period, you may be subject to a late enrollment penalty (LEP):
What it is:
The LEP is an extra amount added to your monthly Medicare Part D premium. It's calculated by multiplying 1% of the national base beneficiary premium by the number of months you went without Part D or other creditable prescription drug coverage.
How much it is
The LEP amount changes each year, but in 2024, it's 1% of $34.70 per month. The penalty is rounded to the nearest $0.10.
How long it lasts
The LEP is usually added to your monthly premium for as long as you have Medicare drug coverage, even if you change your plan.
How to appeal
If you receive a letter notifying you of the penalty, you can file an appeal within 60 days.
How to get help
You can contact your local State Health Insurance Assistance Program (SHIP) for free counseling and assistance. You can find your local SHIP office at www.shiptacenter.org.
You may be subject to the LEP if you:
Don't join a Medicare drug plan when you first get Medicare
Go 63 days or more without creditable drug coverage