Skip to content

How much is the late-enrollment penalty for Medicare Part B?

En español | If you don’t sign up for Medicare Part B when you are first eligible and don’t qualify for a special enrollment period, the penalty adds an extra 10 percent of the standard Part B premium for each 12-month period when you could have had Part B but didn’t.

If you must pay the Part B penalty, you’ll pay it forever, just like a penalty for the Part D prescription plan. That contrasts with a Part A hospitalization enrollment penalty, which lasts a finite time. 

You don’t have to sign up for Part B, which covers doctor’s visits and tests, diagnostic screenings, durable medical equipment and other outpatient services. But to avoid late-enrollment penalties, you need to meet enrollment deadlines.

How is the Part B late-enrollment penalty calculated?

You generally need to sign up for Medicare parts A and B during your initial enrollment period (IEP), which begins three months before the month you turn age 65 and ends three months after the month you turn 65.

You may be able to delay enrolling in Medicare if you or your spouse is still working and you have health insurance through either of your employers. But after losing your job-based coverage, you have to sign up during the special enrollment period while you’re working or within eight months of losing your health insurance.

If you don’t sign up during your IEP or a special enrollment period, you will face two consequences:

  1. A short enrollment window. You’ll be restricted to signing up during a general enrollment period (GEP), which runs from Jan. 1 to March 31 each year. In the past, coverage would not begin until July 1; however, coverage in 2023 will begin the first of the month after the month you enroll during the GEP.

  2. A potential late penalty. Most people don’t pay a penalty for late enrollment in Medicare Part A, which covers hospitalization, because they or their spouse has paid Medicare taxes for at least 10 years and they qualify for premium-free Part A. But that won’t shield them from a Part B penalty if they could have signed up but didn’t. For example, if you enroll in Part B 26 months late, you’ll have to pay a $34 late-enrollment penalty every month in 2022, rounded to the nearest 10 cents from $34.02, in addition to your $170.10 Part B premium. That’s 20 percent of $170.10 because the penalty is based on 12-month periods.

Since Part B premiums usually rise each year, your late-enrollment penalty will rise, as well. The penalty lasts for as long as you have Medicare Part B, whether you have coverage through original Medicare or a Medicare Advantage plan.

If you should have signed up for Medicare at age 65, the penalty calculation is based on the time that elapsed between the end of your IEP and the end of the GEP in which you finally sign up. If you delayed enrollment after age 65 because you were receiving health insurance through your or your spouse’s active employment, the penalty calculation is based on the time between the end of the employment — not the end of your special enrollment period eight months later — and the end of the GEP in which you finally sign up.

What are exceptions to the Part B late-enrollment penalty?

You don’t have to pay a penalty if you sign up for Medicare Part B within eight months of losing your job-based coverage. There are also these other exceptions:

• Less than a year without Part B. If you miss your enrollment deadline but sign up during the next GEP, and in the meantime fewer than 12 full months have lapsed, you will not pay a penalty. So, if your IEP ends May 31, 10 months will have passed before the March 31 end of the GEP.

• Problems with phone signup. In 2022 you have extra time to enroll in Medicare without penalties if you had trouble signing up since the beginning of the year because of problems with the Social Security Administration’s phone system. The SSA handles enrollment for Medicare parts A and B.

This “equitable relief” gives you until Dec. 30, 2022, to enroll, even though the GEP is over. The time between your failed attempt at enrollment in 2022 and when you signed up with equitable relief won’t count toward the late-enrollment penalty.

• A reset of the penalty clock. If you are younger than 65, have Medicare because of a disability and are paying Part B late penalties, you will no longer pay them after you turn 65. At that point, you become eligible for Medicare based on age instead of disability.

• Medicaid. If you are enrolled in this federally financed but state-run health program for people with incomes below a certain amount, in addition to Medicare, your state pays your Part B premiums. Any late penalties are waived.

• Medicare Savings Programs (MSPs). If you qualify for state assistance in paying Medicare costs under one of the MSPs, the state pays your Part B premiums and you are not liable for any late penalties.

• Living abroad. If you live outside the United States and its territories and are not entitled to premium-free Part A benefits, you cannot enroll in Part A or Part B abroad. Instead, you get a special enrollment period of up to three months after you return to the U.S. If you enroll at that time, you are not liable for Part A or Part B late penalties.

Keep in mind

Only health insurance coverage from your own or your spouse’s current employer counts for a special enrollment period to avoid the late-enrollment penalty. Having retiree health benefits or COBRA extended coverage from a former employer after age 65 will not exempt you from Part B late penalties if you don’t meet your enrollment deadline.

But if you have prescription drug coverage from these or other sources that is considered to be at least as good as Medicare’s, that coverage may count as “creditable prescription drug coverage” to avoid the Part D late-enrollment penalty.

Updated June 13, 2022

     

        


Today's Topics

View More

Latest Health News

View More