What is Plan D Penalty - Haven't Ever Enrolled


New Member
I'm 94 and have never enrolled in an Plan D Rx program. My prescription costs have always been reasonably low and decently priced through membership at the SAMS Club and its pharmacy. I'm now residing in senior care assisted living facility that has decided that all prescriptions must now be purchased and facilitated through their partnership with the Remedi pharmacy. Without any Rx insurance plan the prescription costs in this arrangement may increase significantly.

A few questions:
1) Can I enroll in a Part D Rx plan now, or do I need to wait for open enrollment in October for the year 2021 plans?
2) Will I have to pay a penalty that gets calculated as 1% / month going back to 2006, or it is only for the target year of the enrollment?
3) Will I have to pay any penalty?
4) How do I determine the actual penalty and how is it paid?
5) When will the penalty be removed?


Well-Known Member
First, congratulations on being 94.

1) Based on the information provided, it sounds like you will need to wait until the annual Open Enrollment Period in October for 2021 plans.

If you receive "Extra Help" from the government to pay your Part B premium, then you do qualify for a Special Enrollment Period to enroll in Part D now without penalty.

Most large assisted living facilities have a Medicare benefits coordinator who can review your specific situation to determine if you qualify for a Part D Special Enrollment Period now.

2-5)Yes, you will owe a penalty unless you are receiving "Extra Help" from the government to pay your Part B premium. You can use the calculator below to determine the monthly penalty amount. The penalty is based on the average Part D premium, not the premium of the plan you select. The penalty amount will change by a small amount each year since the average Part D premium changes each year.

The penalty can be removed under two circumstances. Either you drop Part D drug coverage or you later become eligible for "Extra Help" paying your Part B premium because your income and assets have decreased.

Part D Penalty Calculator: https://amplicare.com/penalty-calculator/

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