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Can I get a Medicare late-enrollment penalty removed?

If you were penalized for delayed Medicare Part B enrollment, you may have the penalty waived if you were advised to delay enrollment and now find you were given bad advice. | Image: digitalskillet1 / stock.adobe.com

Reviewed by our health policy panel.

Q: Someone gave me bad advice and I delayed enrolling in Medicare Part B. Now I’m told I’ll owe a late penalty, and have to wait months for my Part B coverage to take effect. Can I get the penalty erased and have my Part B take effect sooner?

A: It depends who told you to delay Part B. You may qualify to have your penalty waived if you were advised by an employee or agent of the federal government – for example by Social Security or 1-800-MEDICARE – to delay Part B. Asking for the correction is known as requesting equitable relief.

What is the late enrollment penalty for Medicare Part B?

Medicare Part B enrollment is complicated, and the wrong decision can leave you without health coverage for months – and lead to lifetime premium penalties. Part B premiums increase 10 percent for every 12-months you were eligible for Part B but not enrolled. People who delay Part B because they were covered through their own or a spouse’s current job are exempt from this penalty, and can generally enroll in Part B without any delays.

However, people who delay Part B enrollment and didn’t have current job-based health coverage can find themselves out of luck. They don’t qualify for the Part B Special Enrollment Period and can’t enroll in Part B until the next General Enrollment Period (GEP), which runs from January to March of each year, with Part B coverage beginning that July. The GEP for the current year may have passed by the time you discover you need Part B, potentially your Part B coverage effective date by an entire year. (More information about the Part B Special Enrollment Period is here.)

Can I get a Part B penalty waived?

People make Medicare enrollment errors for a variety of reasons, and equitable relief is not available for all of them.

If you find yourself without Part B coverage or are paying a penalty because you received bad advice from the federal government, Social Security may be able to waive your Part B penalty, enroll you into Part B, or do both things. This can be a big help if you would have otherwise had to wait to enroll during the GEP. (Unfortunately, you can’t get equitable relief if you were misadvised by your employer. In my experience, human resources departments often give out bad advice about Part B.)

You can ask to be enrolled in Part B with a retroactive effective date if bad advice caused you to have a gap in coverage. If you do this, you’ll need to pay Part B premiums for the entire time you want to be enrolled. Alternatively, you can ask to have the Part B penalty waived and just be enrolled going forward. Be sure to clearly specify what it is you want Social Security to do when you make your request.

How do I appeal a Medicare Part B penalty?

You’ll want to document as much information as possible about when someone from the government told you not to take Part B. This can include the date and time of your conversation or phone call, the name of the person you spoke with, and what you did as a result of the information you were given.

Once you’ve put everything together, you can submit your equitable relief request to your local Social Security office. (Contact Social Security at 1-800-772-1213 for the mailing address to use.) There is no time limit for Social Security to respond to your request for equitable relief, so be prepared to follow up at periodic intervals. It can also be helpful to involve an elected representative who can advocate on your behalf. You’ll also want to keep a copy of your request for your records.

(You may be eligible for equitable relief if you delayed or declined Medicare Part B because you had coverage through a Qualified Health Plan purchased from the health insurance marketplace. The rules for this type of relief are stricter and are time-limited. More information about that is available here.)


Josh Schultz has a strong background in Medicare and the Affordable Care Act. He coordinated a Medicare ombudsman contract at the Medicare Rights Center in New York City, and represented clients in extensive Medicare claims and appeals. In addition to advocacy work, Josh worked on federal and state health insurance exchanges at the technology firm hCentive. 

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Royal jones
1 year ago

Same about part D prescription drug coverage. I wasn’t told the full story about the penalty to pay forever. Why should have to enroll in something you don’t need at the time. It’s all about your money and how they can get it!! Another bad thing is you can’t get your congressman to even talk about it. It don’t put money in their pockets.

CAROLYN TRUSSELL
1 year ago

I have been trying to get a late enrollment fee removed. Because of the THIRD PARTY medicare has involved in this, I can not get it removed.
First of all, there should not be any third party involved. They do not know what they are doing . So I ended up with a late enrollment fee since
2009. I have had the prescription card since I went on medicare, which is Covington RX. I moved to TX and then changed over to United Healthcare, as
I was told that Covington RX was not in TX. I want this corrected and I want to receive a refund of the fee that has been charged to me, since 2009.
Carolyn Trussell

nan bergau
1 year ago

I live & work overseas (since 1980) & have private health insurance. I am 73 but, never registered for medicare. Iwant to begin collect SS but, need a medicare number. Do I qualify for a waiver ?

Pete jedrey
8 months ago

I am still employed,but company has no insurance to offer me.
Being 65 in September can I still sign up for enrollment
.

Editor
8 months ago
Reply to  Pete jedrey

Your eligibility for Medicare isn’t impacted by whether you have access to coverage through an employer.
Here is more information about signing up for Medicare: https://www.medicareresources.org/medicare-eligibility-and-enrollment/how-do-i-enroll/

barbara anderson
7 months ago

I was not informed about the penalty for not signing up on time. When I did, the lady I had been working with failed to file my filing. I didn’t know this until the next year during the enrollment period, when I reported back to her office….I do not remember why I did that, but she found my application and it had not been filed. As a result I was and have been assessed a late penalty since that time. I am 83 now….I do not understand why penalties are assessed for signing up late.

7 months ago

We live abroad hence did not register for part B. We now wish to move back to the US and kive in California. Can we file for waiver of penalty, if so can you advise best way to do so? Thanks

Editor
5 months ago

Hi Esther,

Unfortunately, there is no ability to avoid enrollment penalties for Medicare Part B because you were living abroad. Because you didn’t enroll in Part B when you first qualified, you’ll need to sign up for it during the Medicare General Enrollment Period (GEP) from Jan to March of each year, and your Part B coverage would begin in July. You’ll probably owe a late-enrollment penalty for Part B due to the years you were eligible for Medicare but not enrolled in it.

When you return to the country, you will receive a special enrollment period to choose a Part D plan, and won’t have to pay a penalty for not being enrolled in that coverage. I know this probably very difficult to hear. Please be sure to reply with any questions.

Thanks,
Josh

jeanette
1 month ago
Reply to  Josh Schultz

I couldn’t find where to log in so I’m piggy backing this post. My question…. my widowed, 63 yr. old, disabled MS patient cousin has been paying a penalty for yrs. She didn’t enroll when she should have because she had medical insurance from her husband’s employment and wasn’t aware of the penalty for late registration. She is on a very limited income. Is there a way that her penalty can be waived. Appreciate any advise you can offer.

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