Unfortunately, some beneficiaries incur unexpected penalties (LEPs) because they delay signing up for Medicare Part B or Part D coverage. However, they may have the right to appeal. In this post, we discuss how to appeal a Medicare LEP.
What is Medicare LEP (Late Enrollment Penalty)
Medicare imposes a Late Enrollment Penalty (LEP) when beneficiaries delay enrollment in Medicare Part B or Part D without having other creditable coverage (such as employer-based insurance).
Those who incur a Part B LEP pay a 10% increase in their monthly premium for every 12-month period they were eligible for Part B coverage but neglected to sign up.
The Part D LEP is calculated as 1% of the national base beneficiary premium multiplied by the number of months the beneficiary was not enrolled in a creditable Part D coverage. The provider of their Part D coverage adds this amount to their monthly premium.
Anyone assessed with one of these penalties will end up paying it for life (as long as they have Part B and/or Part D coverage). In other words, it is essential to enroll in coverage in a timely manner and act quickly if the penalty assessment may be an error.
Watch a YouTube video on OEP, SEPs & LEPs
When to appeal an LEP
Those who did not enroll in Medicare Part B and/or Part D but had creditable coverage should appeal the penalty. This happens when individuals have employment-based insurance. If this is the case, ask the employer for a letter proving enrollment and include it with the appeal forms.
In some cases, there could be a mistake and beneficiary was actually enrolled in Part B during part or all of the period in question. When this happens, they can use MSNs showing payment for care as proof of enrollment.
If the beneficiary is enrolled in an MSP plan, they are not charged LEPs.
In some instances, there are extenuating circumstances that prevent individuals from enrolling such as; natural disasters or health conditions. Sometimes individuals receive misinformation from either Medicare or a plan representative that causes them to miss an enrollment period.
How to appeal a Medicare LEP
Step 1: Review the penalty notice
If Medicare applies an LEP, you’ll receive a letter from your plan provider explaining:
- The reason for the penalty
- The amount
- How to appeal
Step 2: Complete the CMS LEP Reconsideration Request Form
Beneficiaries have 60 days from the date on the penalty letter to file an appeal. The LEP reconsideration request form comes with the notice. If you cannot locate one, call the plan provider and request one or use one below.
Click here to download a Part D LEP Reconsideration Request form
Download a copy of the Part B LEP Reconsideration Request Form
Step 3: Gather Supporting Documents
Include any relevant documents, such as:
Proof of prior creditable coverage (letters from past employers or insurers).
Records showing you received misinformation from Medicare or a plan representative.
Medical records or other documentation supporting an extenuating circumstance.
Step 4: Submit Your Appeal to C2C Innovative Solutions
The independent contractor handling Medicare LEP appeals is C2C Innovative Solutions, Inc.
- The address and contact details will be on your penalty notice.
- Send copies, not originals, of supporting documents.
Step 5: Wait for a Decision
C2C will review your appeal and issue a decision within 90 days. If the appeal is approved, the penalty is removed or adjusted. If denied, you may have further appeal rights.
Remember
Act quickly; there is limited time to appeal.
Keep copies of all documents you send.
Check your Medicare records to ensure accuracy.
Avoiding or appealing an LEP can save money in the long run. If there is any doubt that the penalty is justified, don’t hesitate to exercise the right to appeal.
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