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Know more about my Medicare options

The Medicare Q&A

Mutual of Omaha understands that things can get confusing when it comes to Medicare. To help you get the information you need, we’ve launched The Medicare Q&A, a recurring feature where we answer some of the most common Medicare questions.¬

Q: Can I get a Medicare Part D late-enrollment penalty removed?

A: First, let’s make clear how the Medicare Part D late-enrollment penalty works. According to Medicare.gov1: The late-enrollment penalty is an amount added to your Medicare Part D monthly premium. You may owe a late-enrollment penalty if, for any continuous period of 63 days or more after your initial enrollment period is over, you go without one of these:

  • A Medicare prescription drug plan (Part D)
  • A Medicare Advantage plan (Part C) (like an HMO or PPO) or another Medicare health plan that offers Medicare prescription drug coverage
  • Creditable prescription drug coverage (prescription drug plans — for example, from an employer or union — are considered “creditable” when they meet or exceed the Centers for Medicare and Medicaid Services (CMS) Standard Medicare Part D Prescription Drug plan)

Your initial Medicare enrollment period occurs when you are eligible to sign up for Medicare for the first time. This seven-month period includes the three months before your 65th birthday, the month that you turn 65, and the three months after your 65th birthday month.

There is a process for reviewing late-enrollment penalties — it’s called “reconsideration.” Start by requesting information from your Part D drug plan sponsor on how to initiate a reconsideration.

Your Part D drug plan sponsor will send you a form to fill out and return. The form lists the reasons a person can ask for and get a review of their case. You must submit the form within 60 days of the date on the letter from your provider notifying you that you owe a late-enrollment penalty. Also, you’ll need to send proof that supports your case, such as a copy of your notice of creditable prescription drug coverage from an employer or union plan.

If Medicare determines there was an error with all or part of the late-enrollment penalty, they will remove or reduce your penalty. Your Part D plan sponsor will send you a letter that shows the correct premium amount and explains if you’re entitled to a refund. If Medicare decides that your late-enrollment penalty is correct, Medicare will send you a letter explaining this decision, and you will be obligated to pay the penalty.

Q: When is the Medicare open enrollment period?

A: Medicare’s open enrollment period for 2021 coverage is October 15 to December 7, 2020. During this time, anyone already enrolled with Medicare can change their Medicare health plans and prescription drug coverage for the following year to better meet their needs.

You should review the information about your Medicare health plan (Original Medicare, Medicare Supplement or Medicare Advantage) or Part D prescription drug plan to see if there will be changes in the upcoming year and if the plan still meets your needs. If you’re satisfied with your current plan and don’t want to change to another plan, you don’t need to do anything — your current plan will stay in effect.

Remember, the open enrollment period is the only time you can change Medicare Advantage and Part D prescription drug plans. If you have a Medicare Supplement plan, you can switch at any time, but may have to answer health questions (known as underwriting) to qualify for a new plan.

Information for next year’s plans will be available beginning in October at Medicare.gov.

Find more information on when to enroll for Medicare.

Q: How much does the average Medicare recipient pay out of pocket for medical expenses?

A: According to a Kaiser Family Foundation report (Medicare Current Beneficiary Survey, 2016), the average Medicare beneficiary paid $5,460 out of pocket for medical expenses in 2016, including premiums as well as out-of-pocket costs. Medicare beneficiaries who had no supplemental coverage paid $7,473 out of pocket for medical expenses. People who had Medigap coverage (a Medicare Supplement or Medicare Advantage plan) paid an average of $6,621 out of pocket, while beneficiaries with Medicare and Medicaid spent the least out of pocket, paying an average of $2,665 in 2016.

Find more information about understanding your Medicare costs.


1 Source: https://www.medicare.gov/drug-coverage-part-d/costs-for-medicare-drug-coverage/part-d-late-enrollment-penalty#:~:text=Your%20Medicare%20drug%20plan%20will,you’ll%20get%20a%20refund.

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