Elder Law Firm of Andrew Olsen

Relief Available for Medicare Part B Penalties

July 20, 2018

There is relief available to some seniors who have incurred a penalty for their late enrollment in Medicare Part B coverage.

Generally, seniors are eligible for Medicare at age 65, when they can receive benefits under Part A (hospital coverage), Part B (outpatient medical coverage), and Part D (prescription drug coverage).

In many cases, seniors apply for Part B coverage during the seven-month initial enrollment period, when Part A is available. In other cases, certain qualified seniors may opt to delay applying for Part B coverage until a later special enrollment period. However, unqualified seniors who delay applying for Part B coverage will eventually incur a steep, permanent penalty of a 10-percent increase in monthly premium payments when they finally enroll.

As it turns out, some seniors did not apply for Part B coverage when they were first eligible. Instead, some of these seniors opted for dual coverage through a combination of Medicare Part A and the less-expensive health coverage through the marketplace affiliated with the Affordable Care Act. Because the marketplace plans are not equivalent to the Part B coverage, those seniors have now incurred a stiff penalty for Part B late enrollment.

How Do You Qualify?

Fortunately, the Centers for Medicare and Medicaid Services (CMS) has offered relief to these particular dually-enrolled seniors by allowing them to enroll in Medicare Part B without a penalty. CMS is also reducing the penalty for those who dropped marketplace coverage and are now paying the Part B late-enrollment fee. CMS has recently extended the deadline to apply for this relief to Sept. 30, 2018.

These dually-enrolled seniors who are eligible for this equitable relief may qualify in the following ways:

  • Their initial Medicare enrollment period began April 1, 2013, or later;
  • They were either notified of retroactive eligibility for premium-free Medicare Part A on Oct. 1, 2013, or later, or had a Part B special enrollment period that ended Oct. 1, 2013, or later;
  • They currently have premium-free Part A and are not enrolled in Part B or have a Part B late-penalty assessed from late enrollment in 2015-18;
  • They must provide documentation showing enrollment in the marketplace;
  • This relief is requested by Sept. 30, 2018.

For most individuals who seek this relief, Part B coverage will begin the month of enrollment. CMS encourages seniors who seek this relief to consult their local Social Security office with case-specific questions about this equitable relief.

Previous post:

Next post: