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Latest news and updates about the Medicare and pharmacy industries.

How Much Will Your Patients Pay in Medicare Late Enrollment Penalties?

Posted on December 2, 2020 by FDS Amplicare Team

Medicare Open Enrollment can be a hectic time for everybody. Seniors have key decisions to make, and you’ve got a lot of patients to care for.

As you estimate plan costs with patients, it’s essential to discuss potential late enrollment fees as well. This “hidden” penalty could significantly impact your patients’ wallets — often without them even knowing it — for the rest of their lives.

The fact is, Medicare Part D late enrollment penalties can be a source of confusion for patients, as most either aren’t aware of this fee or believed they were enrolling on time.

Unfortunately, seniors who sign up for Part D after their Initial Enrollment Period will see a permanent increase to their monthly premiums, even if they’re signing up during Medicare Open Enrollment. Further complicating the matter for pharmacists who want to keep their patients informed is that these fees aren’t exactly easy to calculate.

Luckily, you can let your patients know the exact fees they could face with the help of our user-friendly tools — before they ever pay a penalty.

Let’s take a closer look at the Medicare Part D Late Enrollment Penalty and how you can better inform your patients by using our Part D Late Fees Calculator to estimate potential monthly fees.

Calculating Part D Late Enrollment Fees: What Pharmacists Need to Know

Seniors who find out they owe late enrollment fees may become understandably frustrated and want an explanation.

By talking openly with your patients about how these fees are calculated before they’re incurred, you can help bring them clarity and cost savings — a big win for quality of care.

To help you address some common questions patients will have, here are some key points about how the Late Enrollment Penalty is calculated:

It’s charged according to the monthly coverage gap between a patient's Initial Enrollment Period and their current sign-up

For example, say patient X’s Initial Enrollment Period ended March 31st, 2018 and she wants to enroll in a plan during this Open Enrollment Period ending December 7, 2020. Since she didn’t have drug coverage from April 2018-December 2020, she will have to pay a late enrollment fee based on her 33-month coverage gap.

There’s a 63-day grace period to enroll without penalty after a patient’s Initial Enrollment Period has ended

If patient X above had signed up within 63 days of her Initial Enrollment Period ending March 31st, 2018, she wouldn’t have to pay a penalty. In this case, she could have avoided these fees by enrolling by June 1st, 2018.

If patients had other creditable prescription drug coverage during this coverage gap, they can present proof and forgo the penalty

A patient simply has to show proof of drug coverage during the gap. This could include a private drug plan, Medicare Advantage plan with drug coverage, etc.

If patients are Dual Eligible/Extra Help, they won’t have to pay the late enrollment penalty

If a low-income patient qualifies for Extra Help during their coverage gap, these fees are waived.

Let patients know about the “reconsideration” process

Medicare offers a “reconsideration” process to change or waive the Medicare Late Enrollment Penalty. This is most commonly used for patients who can show proof of drug coverage or being low-income status during their coverage gap.

If you identify any patients who perhaps shouldn’t be paying these late enrollment fees, you can reach out to them about the “reconsideration” process and how it could help them save on costs.

Let us do the hard work to calculate your patients’ late fees 

Whew, that was a lot of info to remember. Luckily, we've got you covered! 

There’s no need to crunch the numbers yourself, since we’ve got a Late Fees Calculator that does all the heavy-lifting for you, using Medicare's official Late Enrollment Penalty formula.

With it, you can calculate fees specific to your patients and find out the final cost of their monthly premiums. Simply enter patient information in a few clicks and get an accurate estimate in seconds.

Remember that the Medicare Late Enrollment Penalty is a monthly fee. That means the number estimated by our Late Fees Calculator will be added on top of patients’ monthly premiums.

It’s a lifelong penalty, so your patients will always pay it in addition to the regular cost of their plan of choice. The permanent nature of the penalty makes it all the more important that seniors avoid it at all costs.

Keep your patients informed about late fees using FDS Amplicare's digital outreach tools

It’s essential that you’re in constant contact with newly eligible and any disenrolling patients to keep them informed of potential penalties. You can use our digital outreach platform, Navigate, to easily connect these groups, even as many seniors are safely socially distancing.

In particular, two common situations tend to result in late fees. Newly eligible patients might decide that they don’t want to enroll because they’re not currently taking any prescription drugs.

Encourage them to enroll anyway! Later, if these patients do need to start taking prescription drugs or want to enroll in Medicare for other reasons, they won’t have to pay the late penalty as they won’t have been without qualifying coverage.

Another typical scenario is for patients who are leaving the Medicare program. It’s important to talk with these patients about why they’re disenrolling. If they want to re-enroll later, they may face late enrollment fees if they didn’t have other drug coverage during that period.

As part of providing great service year-round, don’t forget to keep your patients informed about the Medicare Late Enrollment Penalty for the sake of their physical and financial health.

Ready to help your patients better understand the total cost of their Medicare plan decision and make late fees a thing of the past? Crunch the numbers in just a few clicks using our calculator today:

[Part D Late Fees Calculator]

[Contact Us for More Info]

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