Part D late enrollment penalty appeal
Medicare beneficiaries who don’t sign up for Medicare Part D coverage during their initial enrollment period and go for a period of 63 or more continuous days without creditable prescription coverage may incur a late enrollment penalty. If the beneficiary receives an LEP and they believe it is in error, they can initiate a Part D late enrollment penalty appeal.
Once a beneficiary enrolls in a Part D plan, the plan notifies them in writing if it is determined that the enrollee has incurred an LEP. If plan administrators believe the enrollee has had a lapse in creditable prescription coverage for a continuous period of 63 days or more. The enrollee receives an LEP Reconsideration Notice and LEP Reconsideration Request Form with the written notification.
Either the enrollee or their representative can ask for a review, or reconsideration, of the LEP. The LEP reconsideration request form provides enrollees a list of circumstances when they can request a review.
LEP Reconsideration Notice
The Part D LEP reconsideration notice gives enrollees an explanation of their right to request a reconsideration of their LEP. Sponsors of Part D plans must complete the notice and send it to the enrollee with the letter notifying them of the imposition of a Late Enrollment Penalty.
To download a copy of the Sample late enrollment penalty reconsideration notice – click here.
Reconsideration Request Form
Part D plan enrollees should use the form, “Part D LEP Reconsideration Request Form C2C” to request an appeal of the LEP decision. The enrollee completes the form, signs it and then send it to One of the options below:
If you are sending via standard mail; C2C Innovative Solutions, Inc., Part D LEP Reconsiderations, P.O. Box 44165, Jacksonville, FL 32231-4165
Sending by courier or tracked mail; C2C Innovative Solutions ,Inc., Part D LEP Reconsiderations, 301 W. Bay St., Suite 600, Jacksonville, FL 32202
You can also send either by fax to; 833-946-1912 or upload the form to the website https://www.c2cinc.com//Appellant-Signup. Once you are on the website, you will need to create an account and follow the prompts from there.
If you have a friend, family member or doctor send the request, that person must be your representative. They can complete the last form in the reconsideration request form. The form is fillable online or you can print it out and fill it from there.
LEP appeal process
The LEP appeal process is conducted by an IRE (independent review entity) that has a contract with Medicare. The IRE notifies the enrollee of the final LEP decision within 90 days of receiving the request. This includes the dismissal of the request.
Please note: If you receive Extra Help, you do not have to pay a Late Enrollment Penalty. Click here to learn more about Extra Help programs.