Medicare Drug Coverage Penalty: How the Part D Penalty For Not Enrolling Works

If you’re aging into Medicare soon, you'll want to understand how the Part D prescription drug coverage penalty works. While you aren’t required to have a drug plan, you are penalized for each and every month that you go without it.

The way the Part D penalty is calculated is sort of confusing (thanks a lot, Medicare!), but we have plenty of examples so that you can understand how to calculate it for yourself.

Disclaimer: We do not offer every plan available in your area. Any information we provide is limited to those plans we do offer in your area. Please contact Medicare.gov or 1-800-MEDICARE to get information on all of your options.

Rest assured that you can contact us at any time if you’d like us to calculate your Part D penalty for you. Reach us at 833-801-7999. That’s what we’re here for!

What Is the Medicare Part D Penalty?

For starters, Medicare Part D, also called your prescription drug plan, is a health insurance plan that helps pay for prescriptions.

If you’re eligible for Medicare Part D, but you choose not to sign up for it, you start getting penalized.

You're only penalized if you’re eligible for Part D and don’t have any other type of prescription drug coverage. For example, if you’re not retired yet and your employer’s health plan has drug coverage, you won’t be facing any penalties.

The Part D penalty continues to go up over time; however, you will not receive the penalty in the form of a bill in the mail – you receive the penalty in the form of a higher premium later on.

The longer you go without Part D drug coverage, the more expensive it will be later on.

Calculate My Part D Penalty

In order to calculate your Part D penalty, you need to know two things:

1. How many months you’ve gone without coverage, and
2. The national base beneficiary premium for the current year.
   

The national base beneficiary premium for 2022 is $33.37. This figure can change every year, although for the past few years, it has actually decreased or remain constant.

Each month you don’t have drug coverage, you’re penalized 1% of that national base beneficiary premium. The final sum is then added on to your monthly Part D premium.

So, let’s say you didn’t have drug coverage for 2 years. That’s 24 months, which means you’d be penalized 24% of the national beneficiary premium that year (1% for each month). In 2020, that would equal a total of $8. The monthly penalty is always rounded to the nearest $0.10.

This means that you’d pay an extra $8 per month (in addition to your regular Part D monthly premium) for the rest of your life.

Medicare Part D Penalty For Late Enrollment

If you’re looking for a Part D penalty calculator, Amplicare has a useful one. Simply put in your birthday, and it will calculate how many months you've gone without coverage. You'll see the penalty addition to your Part D premium without having to do any calculations yourself.

We also have three examples to help you better understand how the Part D penalty works.

Part D Penalty Example #1

Let's say that it’s currently May of 2022. You haven’t had prescription drug coverage since December of 2020. That means you haven’t had drug coverage for a total of 16 months.

It’s 2022, and the national base beneficiary premium is $33.37.

So, here’s your Part D penalty calculation:

$33.37 x .16 = $5.33

Now, we round to the nearest $0.10, so your Part D penalty would be $5.30 per month.

Part D Penalty Example #2

Here’s another example.

Let's say it’s currently September of 2022. You forgot to sign up for a Part D plan in May, so it’s been 4 months since you’ve had creditable drug coverage.

Here’s your Part D penalty calculation:

$33.37 x .04 = $1.33

Your Part D penalty would be $1.30 per month.

Part D Penalty Example #3

One more example just to make sure you’re golden!

Let's say it’s currently August of 2022. You decided not to get Medicare Part when you turned 65, which was in February of 2013. That means you haven’t had Part D drug coverage for 114 months.

Here’s your Part D penalty calculation:

$33.37 x 1.14 = $38.04

Now, we round to the nearest $0.10, so your Part D penalty would be $38 per month.

In all of these examples, your final calculation should be rounded to the nearest 10 cents. This is the fee you’ll have to pay in addition to your regular Part D premium each month. This fee does not go away for the life of the policy.

So, if you end up choosing a Part D drug plan that costs $40 per month, and we’re using the final example, your monthly bill would actually be $40 + $38, or $78 per month.

Do I Have a Part D Penalty?

If you’re unsure about whether you will end up owing a penalty, you can contact us at any time.

Also, when you do sign up for a Part D plan, that plan will tell you if you owe a penalty. You will also know what your total monthly premium will be.

Avoiding the Medicare Part D Penalty

In order to avoid the Medicare Part D penalty, don’t go without creditable drug coverage.

Here’s what we recommend:

1. Join a Part D plan when you’re first eligible. For most people, this is when they turn 65, and even if you don't have any ongoing prescriptions, these plans are really inexpensive (sometimes as low as $20 or less per month). However, your agent – or one of our experts here at Medicare Allies – can confirm that for you.
2. Don’t go over 60 days without a drug plan – this could be Part D or some other type of creditable drug plan (through your employer, for example).

If you need help with your drug plan, feel free to use the DIY Part D tutorial, or you can contact us to get help from one of our trusted advisors.

We’re always available to answer your questions. All you have to do is give us a call at 833-801-7999.