ASKING FOR RECONSIDERATION OF YOUR PART D LATE ENROLLMENT PENALTY (LEP)

There are two ways to dispute your Late Enrollment Penalty (LEP); either through Attestation or Reconsideration. Please read carefully to determine which scenario applies to your situation.

You may submit an Attestation in writing or verbally over the phone (telephonic attestation) within 30 days from when your "Declaration of Prior Prescription Drug Coverage” letter was mailed. Attestations are handled through Cigna-HealthSpring. Please contact our Customer Service Department for assistance.

Reconsideration is another option to dispute your LEP if you have missed the 30 day window for the attestation. If you did not complete the "Declaration of Prior Prescription Drug Coverage” or a telephonic attestation within the time frame required, you may request Reconsideration.

Example:

Mrs. Smith termed with ABC Health Plan in December 2012. Mrs. Smith enrolled into XYZ Health Plan January 2014 and accrued a 12 month gap in coverage. Mrs. Smith disenrolled from XYZ Health Plan Dec. 31, 2014 and became effective with Cigna-HealthSpring on January 1, 2015. Mrs. Smith cannot attest the pre-existing LEP, but a Reconsideration request can be submitted to Maximus (CMS Third Party Vendor). Download a reconsideration form. English / en Español

Get more information on the Late Enrollment Penalty.

The late enrollment penalty is calculated by Medicare, not the plan, when a person first joins a Medicare drug plan. The late enrollment penalty amount is 1% of the national base beneficiary premium (also called “base beneficiary premium”) for each full, uncovered month that the person was eligible to join a Medicare drug plan and didn’t. The monthly penalty is rounded to the nearest $0.10. The national base beneficiary premium for 2015 is $33.13.

Mrs. Martin didn't join a drug plan when she was first eligible—by July 2012. She doesn't have prescription drug coverage from any other source. She joined a Medicare drug plan during the 2014 Open Enrollment Period, and her coverage began on January 1, 2015.

Since Mrs. Martin was without creditable prescription drug coverage from August 2012–December 2014, her penalty in 2015 is 29% (1% for each of the 29 months) of $33.13 (the national base beneficiary premium for 2015), which is $9.61. The monthly penalty is rounded to the nearest $.10, so she'll be charged $9.60 each month in addition to her plan's monthly premium in 2015.

Here's the math:

.29 (29% penalty) × $33.13 (2015 base beneficiary premium) = $9.61

$9.61 (rounded to the nearest $0.10) = $9.60

$9.60 = Mrs. Martin's monthly late enrollment penalty for 2015

In general, once a person’s penalty amount is determined by Medicare, the person will continue to owe a penalty for as long as he or she is enrolled in a Medicare drug plan. This means that even if the person decides to join another Medicare drug plan, he or she will still have to pay a penalty when they join a new plan. This also means that if a person joins a plan that has a $0 monthly premium, he or she will still owe a penalty.

The base beneficiary premium will change each year. This means that each year Medicare will use the current coverage year’s amount to calculate a person’s new penalty amount. In 2014, the base beneficiary premium was $32.42. In 2015 the base beneficiary premium is $33.13.

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