Note: This column was updated on Jan. 4 to correct the formula for the Medicare Part D penalty.
Toni,
I need your help! I have discovered that my mother, who is 67, never enrolled in Medicare Part B or D. She was under the impression that if she did not go to the doctor, she did not need to pay the premium, saying she needed the money to pay for her car payment and could enroll later.
She has been diagnosed with colon cancer. I called Social Security to help her enroll in Part B and was informed that she must wait until Jan. 1 to enroll. The Social Security agent said that my mother has missed her “window of opportunity,” since she did not enroll when she turned 65, and that she is going to receive a penalty. Please advise me; what can I do to help her? Thanks, Toni.
— Jeanine from El Paso, Texas
Oh my, Jeanine,
Your mother has an extremely serious Medicare issue! She will have to enroll during Medicare’s general enrollment period, which is from Jan.1-March 31 each year for those who never enrolled in Medicare Parts A and B. Your mother will receive the famous Part B penalty for the rest of her Medicare life.
Beginning Jan.1, 2023, Medicare’s general enrollment period rules changed to help Americans who had not enrolled in Medicare when turning 65. Now when you enroll in January, February or March, your Medicare Part B will begin the first day of the following month. If you wait past March 31 to enroll, your Medicare enrollment will be delayed until Jan.1 of the next year, and you’ll receive a higher Part B penalty, which will go all the way back to the month you turned 65.
Jeanine, when your mother enrolls in Medicare Part B during the enrollment period, she will receive the Part B penalty: 10% for each year she failed to enroll. Her penalty will be 20% (two years times 10%) for as long as your mother could have had Part B but failed to enroll. The penalty remains in effect for the life of the Medicare beneficiary’s Medicare coverage.
For your mother to enroll in a Medicare Part D plan, she must wait until the next Medicare annual enrollment period, which is Oct. 15-Dec. 7. The Medicare Part D plan will start Jan. 1.
Readers, the Medicare Part D penalty is 1% for each month that you could have but failed to enroll in Part D from age 65. This penalty, which is based on the national Part D average premium, also changes as the average changes.
Medicare enrollment periods are:
— Initial enrollment period: The seven-month window that begins three months before turning 65, the month one turns 65 and three months after one turns 65.
— Special enrollment period: The eight-month window of signing up for Part B without receiving a Part B penalty after turning 65. One must be working full-time with company benefits to avoid the penalty.
— General enrollment period: Jan. 1-March 31 for anyone who has not enrolled in Part B and now can enroll in Medicare Part B beginning the next month. You will receive a Medicare Part B penalty if you are past your initial enrollment period and do not meet the criteria for the special enrollment period.
Currently, there are over 7 million Americans on Medicare receiving a Medicare Part B penalty costing, on average, $5,000 in Medicare lifetime penalties, all because they did not enroll at the right time. As we say at Toni Says, with Medicare, what you don’t know will hurt you.
Toni King is an author and columnist on Medicare and health insurance issues. She has spent nearly 30 years as a top sales leader in the field. If you have a Medicare question, email info@tonisays.com or call 832-519-8664. Toni’s books and her newsletter are available at tonisays.com. Toni’s new Confused about Medicare video series is now available for purchase at tonisays.com, as are Toni’s Medicare Survival Guide and discounted bundle package.