Part D LEP appeal form
If a Medicare beneficiary does not sign up for a Medicare Part D plan during their IEP (initial enrollment period) and has a period of more than 63 continuous days without having a creditable prescription drug plan, they will incur a LEP (late enrollment penalty). If they receive an LEP, they can file a Part DLEP appeal form.
In some cases, a Part D plan provider imposes an LEP on a beneficiary once they enroll in a plan. If the plan provider believes there has been a lapse in creditable drug plan coverage for over 63 days and is imposing the penalty , they must send a written notice to the enrollee. The enrollee receives a LEP reconsideration request form with the letter informing them of the penalty. This gives the enrollee the opportunity to initiate a Part D late enrollment penalty appeal.
Click here to download the LEP Reconsideration Request Form
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Reconsideration Notice
If the enrollee receives a Part D LEP reconsideration notice, it includes an explanation of their right to request a reconsideration of the LEP. Any Part D plan provider who adds the LEP to the enrollees plan premium must send the enrollee a letter notifying them of the imposition of a Late Enrollment Penalty as well as instructions to complete the LEP reconsideration request form.
Please note: either the enrollee or their representative can request a reconsideration, of the LEP. The LEP reconsideration request form provides a list of situations when a review can be requested.
Learn about Part D enrollment
To view a sample LEP reconsideration notice – click here.
Reconsideration Request
If an enrollee wants to request a reconsideration of the LEP, they must submit the form, “Part D LEP Reconsideration Request Form C2C” . Once the form is completed, use one of the methods below to send it in:
To send the form by standard mail; C2C Innovative Solutions, Inc., Part D LEP Reconsiderations, P.O. Box 44165, Jacksonville, FL 32231-4165
If you prefer to send it by courier or tracked mail, use the following address; C2C Innovative Solutions ,Inc., Part D LEP Reconsiderations, 301 W. Bay St., Suite 600, Jacksonville, FL 32202
For faster results, enrollees can send either by fax to; 833-946-1912 or they can go to the website https://www.c2cinc.com//Appellant-Signup create an account and upload the completed form there.
In the event the enrollee has a friend, family member or doctor send the request, that individual must be their representative. If this is the case, the representative must complete the last page of the reconsideration request form. They can either fill the form out on line or print it and fill it out.
Click here to download the LEP Reconsideration Request Form
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: Enrollees who receive Extra Help, do not have to pay the Late Enrollment Penalty. Click here to learn more about Extra Help programs.
Additional information; if the enrollee has income above a certain level, they may be assessed an IRMAA, click here to learn what that means.
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