If you were without Part B Part B, also known as medical insurance, is the part of Medicare that covers most medically necessary doctors’ services, preventive care, hospital outpatient care, durable medical equipment (DME), laboratory tests, x-rays, mental health services, and some home health care and ambulance services. or job-based insurance for more than 12 months while eligible for Medicare, you may face a Part B late enrollment penalty (LEP). The penalty is 10% of the Part B ($185 in 2025) for every 12-month period you did not have Part B or job-based insurance that allowed you to delay enrollment Enrollment is joining Original Medicare or becoming a member of a Medicare Advantage Plan or Part D plan. . This amount is added to your monthly Part B premium.
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Get Help Applying for Medicare Cost-Savings Programs
If you live in New York, the Medicare Rights Center can help you enroll in various Medicare cost-savings programs. Please answer a few questions to see if we can connect you with a trained benefits enrollment counselor.
Contact your local State Health Insurance Assistance Program
Each state offers a SHIP, partly funded by the federal government, to give you free counseling and assistance. A SHIP counselor may be available by phone or in person.
Visit www.shiptacenter.org to find your local SHIP office.
Contact your local State Health Insurance Assistance Program
Based on the information you provided, you do not appear to be eligible for Medicare cost-saving programs.
[glossary_exclude]Each state offers a State Health Insurance Assistance Program (SHIP), partly funded by the federal government, to give you free counseling and assistance. A SHIP counselor may be available by phone or in person.[/glossary_exclude]
Visit www.shiptacenter.org to find your local SHIP office.
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Note: You can eliminate your penalty if you are eligible for a Medicare Savings Program (MSP).
Appealing the LEP
Everyone has a right to file an appeal An appeal is a formal request for review if you disagree with an official health care coverage or payment decision made by a Medicare Advantage Plan, a Medicare private drug plan (Part D), or Original Medicare. Federal regulations and law specify appeals deadlines, processes for handling appeals, what information must be included in a decision, and the levels of review in the appeals process. with the regarding their LEP determination.
To appeal, follow the directions on the letter informing you about the penalty. If you do not have an appeal form, you can use SSA’s request for reconsideration form.
You can appeal to remove the penalty if you think you were continuously covered by Part B or job-based insurance. You can also appeal to lower the penalty amount if you think it was calculated incorrectly.
Unfortunately, being unaware of the requirement to enroll in Part B is unlikely to be a successful argument for an appeal. However, the following are reasons to appeal that may result in the elimination or reduction of your penalty:
- You had job-based insurance during some or all of the time period in question
- Call your former employer or plan and ask for a letter proving that you were enrolled in coverage. Make sure to attach this letter to your appeal form. Other forms of evidence include income tax returns that show Health Insurance Health insurance (sometimes called health coverage) pays for some or all of the cost of health services you receive, like doctors’ visits and hospital stays. Programs like Medicare and Medicaid are public health insurance offered through the government. Health insurance can also be administered by private companies that offer individual policies, group health plans, and supplemental insurance. premiums paid, W-2s reflecting pre-tax medical contributions, pay stubs that reflect health insurance premium deductions, health insurance cards with policy effective date, explanation of benefits paid by health plan, and statements or receipts that reflect payment of health insurance premiums.
- You were actually enrolled in Medicare Part B during some or all or the period in question
- If the penalty is being assessed in error because you were actually enrolled in Part B, you can include proof of that coverage, including Medicare Summary Notices (MSNs) showing payment for care, statements showing premiums paid, or other records.
- You have a new Initial Enrollment Period (IEP).
- You are enrolled in an MSP.
The appeal deadline is 60 days from the date you received the letter informing you about the penalty. If you miss this deadline, you can write a letter explaining why you had good cause, or a good reason—like serious illness—that prevented you from appealing on time. Attach this letter to your appeal.
Be sure to pay the LEP while SSA reviews your appeal. If your appeal is successful, you will be refunded for LEP payments you made while your appeal was being reviewed.