To avoid a Medicare Part D late enrollment penalty, you must enroll in a Medicare drug plan during your Initial Enrollment Period (typically when you turn 65) or maintain "creditable" prescription drug coverage—such as from a current employer, union, or VA—for 63+ consecutive days without a break. If you lose creditable coverage, you must enroll within 63 days to avoid the penalty.
you must join a new Medicare Part D drug plan in fewer than 63 days. If not, you may pay a penalty if you sign up for Medicare drug coverage after 63 days. Keep records of your prior drug coverage—When you join a new drug plan, you'll need proof of your previous creditable prescription drug coverage to avoid a penalty.
Generally, the Part D late enrollment penalty is added to the person's monthly premium for as long as they have Medicare drug coverage, even if the person changes their Medicare plan. This also means that if a person joins a plan that has a $0 monthly premium, they'll still pay a monthly late enrollment penalty.
For more information, see If You Delay Enrolling in Part B. Note: If you were younger than age 65 when you became eligible for Medicare and incurred a late enrollment penalty for either Part B or D, that penalty will be waived when you turn 65.
Penalties if You Don't Enroll in a Part D Plan
$38.99 in 2026; this figure changes each year) for every month you were eligible and did not enroll. This amount is added on to your drug plan premium.
You generally need Medicare Part D (prescription drug coverage) if you have Medicare and don't have other "creditable" drug coverage (like from an employer or VA) to avoid a permanent late enrollment penalty, even if you don't take meds now; you can get it as a standalone plan or with Medicare Advantage, and it's optional but highly recommended to prevent future costs and penalties, say sources from Medicare.gov, AARP, and Healthgrades.
Yes, you can cancel Medicare Part D during specific enrollment periods (like the Annual Election Period Oct 15–Dec 7) or if you qualify for a Special Enrollment Period (SEP) (due to life events like moving or losing other coverage), but you may face a late enrollment penalty if you go without creditable drug coverage for 63 days or more, so it's crucial to have other valid coverage or risk higher premiums later. To cancel, contact your plan or call 1-800-MEDICARE during an eligible time and submit a written or online request.
you can file an appeal. Before you start an appeal, you can ask your provider or supplier for any information to make your appeal stronger. If you're in a Medicare Advantage plan, other health plan, or a drug plan, check your plan materials, or contact your plan, for details about your appeal rights.
Generally, you're first eligible to sign up for Part A and Part B starting 3 months before you turn 65 and ending 3 months after the month you turn 65. (You may be eligible for Medicare earlier, if you get disability benefits from Social Security or the Railroad Retirement Board.)
Part D late enrollment penalty
You'll pay an extra 1% for each month you could have signed up for Part D, but didn't, and didn't have creditable drug coverage. We'll add this penalty to your monthly Part D premium. , it'll be added to your monthly premium.
The penalty for not having Medicare Part D (or creditable drug coverage) is a lifelong late enrollment penalty (LEP) added to your monthly premium, calculated as 1% of the national base beneficiary premium for each full, uncovered month you were eligible but didn't enroll, using the current year's base premium (e.g., ~$38.99 in 2026). This means a longer delay results in a higher permanent monthly fee, which increases each year and is paid for as long as you have drug coverage, even if you switch plans.
To successfully appeal a Medicare denial, thoroughly read denial notices, understand the reason for denial, and then file a written appeal within deadlines, including a doctor's letter of medical necessity, supporting records, and your Medicare ID, ensuring you keep copies of everything and send it via certified mail for strong evidence. Follow the instructions on your Medicare Summary Notice (MSN) to start with a Redetermination, and if denied again, proceed to subsequent levels like Reconsideration, always providing strong documentation.
Medicare Part D changes in 2025, driven by the Inflation Reduction Act (IRA), introduce a significant $2,000 annual out-of-pocket (OOP) cap, eliminating the coverage gap ("donut hole") and creating three simplified phases: deductible, initial coverage, and catastrophic coverage with $0 OOP costs after the $2,000 threshold is met, benefiting many beneficiaries with lower overall drug spending. Other key updates include shifts in liability, a new manufacturer discount program, and some plans increasing premiums, making 2025 a big year for Part D reform.
Employer coverage: If you were covered by an employer or your spouse's employer when you first became eligible, you may delay enrollment without penalty. Medicaid or state programs: If you qualify for Medicaid, you're protected from penalties.
Generally, this is when you're first eligible to sign up for Part A and Part B. It starts 3 months before you turn 65 and ends 3 months after the month you turn 65. , unless you have other coverage that's similar in value to Medicare (like from an employer).
Here are some of the biggest Medicare mistakes to avoid:
The Medicare 2-Midnight Rule is a Centers for Medicare & Medicaid Services(CMS) guideline for hospital admissions, stating that if a doctor expects a patient to need hospital care crossing at least two midnights, the stay generally qualifies for Medicare Part A inpatient payment;
Establish an Irrevocable Trust
Cash, property, and investments can be transferred into an irrevocable trust. By doing so, these assets would be removed from Medicaid's calculation. However, this trust would need to be established at least five years before applying for Medicaid to avoid lookback scrutiny.
You can get a Medicare Part D penalty waived if you qualify for Extra Help, had creditable prescription drug coverage (like from an employer or VA) for at least 63 continuous days when not in a plan, or if you appeal the penalty, proving miscalculation or lack of notice, using forms like the CMS-1696 form from Medicare.gov or your plan. The penalty is a permanent addition to your premium unless an exception or successful appeal occurs, often involving proving you had similar coverage for 63+ days or qualifying for Extra Help.
Grounds of appeal are the specific legal reasons a party claims a lower court's decision was wrong, typically involving mistakes of law, errors in procedure (like improper evidence admission or jury instructions), constitutional violations, abuse of discretion, or insufficient evidence, all arguing the trial's unfairness or incorrect legal application to justify a higher court reviewing and potentially overturning the judgment.
You may delay Part B and postpone paying the premium if you have other creditable coverage. You'll be able to sign up for Part B later without penalty, as long as you do it within eight months after your other coverage ends. You'll need to inform Medicare of your decision before your Part B coverage starts.
If you don't sign up for a Part D plan when you are first eligible to do so, and you decide later you want to sign up, you will be required to pay a late enrollment penalty equal to 1% of the national average premium amount for every month you didn't have coverage as good as the standard Part D benefit.
If you move outside the United States: Medicare Part A (hospital insurance), is available to you if you return. No monthly premium is withheld from your Social Security benefit payment for this protection. You can continue paying for your Part B benefits or drop them while out of the country.
Part D coverage is not mandatory, but individuals who wait to sign up for Part D after they become eligible may incur penalties if they do go to enroll. If you qualify for a special enrollment period or Medicare's Extra Help program, you will not pay a late enrollment penalty after delaying Part D enrollment.