If you were without Part B 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 premium ($164.90 in 2023) for every 12-month period you did not have Part B or job-based insurance that allowed you to delay enrollment. This amount is added to your monthly Part B premium.
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 with the Social Security Administration (SSA) 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 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.