Medicare penalties could cost your clients.
Calculate potential Medicare Late Enrollment Penalties (LEP) and get a crash course in avoiding them.
Missing Medicare enrollment periods can cost your clients thousands
Part A LEP
Up to 10% higher premiums for twice the number of years they could have had coverage
Part B LEP
10% increase for each 12-month period enrollment was delayed, for as long as they have Medicare
Part D LEP
Additional 1% per month without coverage, added to their premium for as long as they have Medicare
Medicare Late Enrollment Penalty Calculator
Medicare Part A eligibility
You're eligible for Medicare Part A when you:
- Are 65 or older and a U.S. citizen or permanent legal resident who has lived in the United States for at least 5 continuous years
- Receive or are eligible for Social Security or Railroad Retirement benefits
- Are under 65 and have certain disabilities
Premium-free Part A
Most people don't pay a premium for Part A when:
- You (or your spouse) has worked and paid Medicare taxes for at least 40 quarters (10 years)
- You're eligible for or receiving retirement benefits from Social Security or the Railroad Retirement Board
Premium-required Part A
You'll need to pay a monthly premium for Part A if you (or your spouse) worked and paid Medicare taxes for less than 40 quarters
About Part A Late Enrollment Penalties
If you're not eligible for premium-free Part A and don't buy it when you're first eligible, your monthly premium may go up 10%. You'll have to pay the higher premium for twice the number of years you could have had Part A but didn't sign up.
The 2025 Part A premium rates are:
- $0 per month if you or your spouse worked and paid Medicare taxes for 40 or more quarters
- $285 per month if you paid Medicare taxes for 30-39 quarters
- $518 per month if you paid Medicare taxes for fewer than 30 quarters
These premium amounts are subject to change annually.
Medicare Part B eligibility
You're eligible for Medicare Part B when you:
- Are 65 or older and a U.S. citizen or permanent legal resident
- Are already enrolled in Medicare Part A
You may also qualify if you:
- Are under 65 and have received Social Security Disability Insurance (SSDI) for 24 months
- Have End-Stage Renal Disease (ESRD) or Amyotrophic Lateral Sclerosis (ALS)
About Part B Late Enrollment Penalties
If you don't sign up for Part B when you're first eligible, you may have to pay a late enrollment penalty for as long as you have Medicare. The penalty is a 10% increase in your monthly premium for each full 12-month period you could have had Part B but didn't sign up.
The standard Part B premium for 2025 is $185 per month. This amount is subject to change annually.
Medicare Part D eligibility
You're eligible for Medicare Part D when you:
- Are enrolled in Medicare Part A and/or Part B
- Live in the service area of a Medicare drug plan
About Part D Late Enrollment Penalties
If you go without Part D or other creditable prescription drug coverage for any continuous period of 63 days or more after your Initial Enrollment Period, you may have to pay a late enrollment penalty.
The penalty is calculated as 1% of the national base beneficiary premium for each month you were without coverage. This penalty is added to your monthly Part D premium and may increase each year as the national base beneficiary premium changes.
The 2025 national base beneficiary premium is $36.78 per month. This amount is subject to change annually.
Avoiding Late Enrollment Penalties
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Eligibility for Medicare
Your clients become eligible for Medicare Part A when:
- They are 65 or older
- They are disabled
- They have End-Stage Renal Disease
- They are eligible for premium-free Part A if they or their spouse have paid Medicare taxes for 40 quarters.
They become eligible for Medicare Part B when:- They are eligible for premium-free Part A
- If they must pay a premium for Part A, they must meet these requirements to enroll in Part B:
- They are 65 or older
- They are a resident of the United States AND
- They are a U.S. Citizen, OR
- They have been lawfully present in the US for five continuous years before applying for Medicare
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Initial Enrollment Period
The Initial Enrollment Period for Medicare is when your clients are first eligible to sign up for Medicare Parts A and B.
The seven-month period begins three months before the month they turn 65, and end three months after that month.
During this time, they can also elect to join a Medicare Advantage (Part C) plan or a Medicare Part D prescription drug plan.
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Special Enrollment Periods - Medicare Parts A and B
Certain situations, like a loss of employer-sponsored coverage after retirement, may qualify your clients for a Special Enrollment Period.
Be careful: they only have eight months from the date they lost employer sponsored coverage to join Medicare without facing a Late Enrollment Penalty for Part A and/or B.
If they are eligible for premium-free Part A, they will not face a late enrollment penalty for that part.
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Special Enrollment Period - Medicare Part D
When they become eligible for Medicare, they must maintain drug coverage that is at least as good as what a Medicare plan offers.
If they lose that coverage, such as when leaving an employer-sponsored plan or other prescription drug coverage, they have 63 days to enroll in new coverage without facing a penalty.
Get guidance from our Medicare experts.
Our team is standing by to answer your questions about Late Enrollment Penalties.
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