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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.

Learn more about enrollment in Part D

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.

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:  If you receive Extra Help, you do not have to pay a Late Enrollment Penalty.  Click here to learn more about Extra Help programs.

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Late Medicare enrollment

Medicare can be confusing; understanding the rules and guidelines for enrollment is important to ensure you have access to the healthcare coverage you need. Although many people are aware of the initial enrollment period, there are situations when individuals may apply for late Medicare enrollment.  We will go over some reasons for late enrollment, the rules surrounding late enrollment, and how to apply for Medicare.

Reasons for Late Medicare Enrollment

Missing your IEP (Initial Enrollment Period) – If you neglected to sign up for Medicare during your IEP, which begins three months before your 65th birthday and extends to three months after, you may need to wait for the GEP to sign up.

Missed a SEP (Special Enrollment Period) – In some cases, a qualifying event such as loss of employer coverage or moving can trigger an SEP.  If you miss this opportunity, you may have to wait for the GEP.

You have employer Coverage after the age of 65 – If either you or your spouse continue to work past the age of 65 and have employer-sponsored health coverage, you may delay Medicare enrollment. Late enrollment is allowed without a penalty as long as you enroll in Medicare within eight months of losing the employer coverage.

Rules and Guidelines for late Medicare enrollment

General Enrollment Period (GEP) – The GEP runs from January 1 through March 31 each year. Those who enroll during this period may face a late enrollment penalty (LEP).  The LEP is added to your Medicare Part A, if you do not qualify for premium free Part A, and Part B monthly premium amount.   For each 12-month period you delay enrollment in Part B, there is a 10% penalty applied.  The penalty lasts for as long as the beneficiary has Part B coverage. That is one reason to enroll in Medicare as soon as you are eligible.

Learn more about the Part B LEP

Medicare Advantage with prescription coverage (MAPD) and stand-alone Part D plans – Individuals who did not have creditable prescription coverage while they were eligible, will also have to pay a Part D penalty for late enrollment.

How to apply for Medicare

Go to the Official Medicare Website – In some instances, beneficiaries can enroll in Medicare online.  This is the easiest way to enroll.  Just visit medicare.gov and you will see options to enroll.  This website provides comprehensive information for those enrolling in Medicare or if you have Medicare questions.

Visit your local Social Security Office – Beneficiaries can either apply for Medicare over the phone by calling 1-800-772-1213 Monday – Friday 8 am – 7 pm.  Tell the representative if you want to apply for Medicare A & B or Part A only.  Hearing impaired beneficiaries can call TTY 1-800-325-0778.

If you want to apply in person, click here to find a local social security office.

Once you have your Medicare coverage in place, it is important to get the help of a licensed Medicare agent who can guide you through the different coverage choices available to supplement your coverage.

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