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Can I get a Medicare late-enrollment penalty removed?

Josh Schultz // October 18, 2022

Reviewed by our health policy panel.

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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 on 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% 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 coverage effective the month following enrollment (coverage used to take effect in July, but that has changed as of 2023). 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. Here’s a sample letter to guide you.

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 or check www.ssa.gov to find the mailing address for your local office.) 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. And understand that there is no appeals process or formal procedure to follow if your request is not granted. But it’s in your best interest to try anyway. 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 between 2014 and June 2020. 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
2 years 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
2 years 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

B Travers
1 year ago

Did you ever receive a refund? I am fighting with them over this right now.

nan bergau
2 years 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
2 years 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
2 years 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
1 year 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.

1 year 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
1 year 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 year 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.

Ajibola Adewusi
10 months ago

I was 65 in Nov 2020, COVID 19 restrictions got me stuck oversea ( Africa ) doing volunteer work for the less privilege. We can’t go anywhere or connect to internet . When restrictions was lifted ,I came back home in Dec 2021 and find myself penalize for life. Can I get a waiver and have my refund .

Robbie Pace
1 year ago

Hi my name is Robbie Pace. I have been assessed a late sign up penalty since 2012. Prior to adding part B, I was enrolled in Medicaid. Medicaid was my main source of medical coverage so I didn’t enroll for Medicare part B. I thought they were under the same umbrella. I found out Medicaid wasn’t a recognized insurance and I was penalized. This penalty has caused me financial problems. Is there help?

GEORGE JAMES
1 year ago
Reply to  Robbie Pace

I received Medicare B on 7/1/2021.I am even today covered by wife’s Federal Employee Program, (she retired in 2016.).WHY SHOULD I PAY PENALTY FROM 2016,AS RETIREMENT DOES NOT CHANGE THE STATUS.

Ellen Barker
10 months ago
Reply to  GEORGE JAMES

Why is there a penalty at all?No one can answer that question? You are not asking for coverage prior to receiving Medicare. Does it cause more work for someone. If there was a reasonable answer I could understand I would be fine. Its punitive and like getting a last punch in to the older generation. Just give me a reason. Ty Ellen Barker

Frankie Parsons
8 months ago
Reply to  Ellen Barker

The reason for the Late Enrollment Penalty and the Election Periods are to prevent people from signing up only when they are sick and need bills paid, and then not paying for coverage/insurance when they are well.

The program is called Medicare Health Insurance. Insurance only works when people buy coverage and don’t need to use it all of the time. The people paying and not using it are subsidizing those who ARE using it. If you look at what you pay in premiums, and what Medicare has paid for you, you will likely find that Medicare has paid far more than the premiums you have put in. If this is not the case, just wait.

My husband complained for 25 years about how insurance was a scam and how he paid for so many years and never got anything out of it. Then he needed a triple bypass. In one year, his bills were almost double everything he had paid in premium for over 20 years.

Tanya Feke, MD
8 months ago

It is true that people often get more out of Medicare than they pay into it, even after years of paying Medicare taxes.

A study by the Urban Institute found that a single man who had an income of $59K and retired in 2020 (at age 65) would have paid $405K in Social Security and Medicare taxes over their lifetime but would get $573K in benefits. For women earning the same amount, they would have paid $405K and received $646K (because women tend to live longer).

A married couple earning $85.7K combined would have paid $586K into the system and would receive $1.11 million in benefits over their lifetime.

Sharon
9 months ago

MY husband has had his part B penalty for over 8 yrs now and we are low income here in San Diego. At age 65 he was in a narcotic drug rehab facility thru the VA for 2 yrs and had no money or income at that time so was advised that he didn’t need part b since his VA coverage would be sufficient. He couldn’t afford it either since his monthly SS was only only $750. WE were separated at that time also. He has been sober now for 10 yrs and we are back together. WE signed up for part b for him as soon as we found out that he would need it to supplement his VA coverage but this penalty amount is unaffordable for us and lasts a lifetime, not fair at all. WHAT can we do to remove this penalty? Thank you.

Tanya Feke, MD
8 months ago
Reply to  Sharon

There are three ways to eliminate your Part B late penalty:

1) If you qualified for Medicare based on a disability before you turned 65, any Medicare late penalties you had would stop when you turned 65. That is when you qualify for Medicare based on age. Essentially, Medicare lets you start with a clean slate.

2) If you are having a hard time paying your Medicare premiums, you may qualify for a Medicare Savings Program. Check with your local Medicaid office to find out. When you are eligible for one of these programs, any Medicare late penalties you had are discontinued. It makes sense that if you cannot afford the premium itself that you would struggle to pay the late penalty too.

3) You could appeal your case to Medicare. However, as this article points out, not every situation is eligible to have the Part B penalty removed. It depends who advised your husband to defer Medicare and what documentation you can gather to support that. Specifically, a federal employee had to have given him that advice.

Romeo Rodriguez
9 months ago

is a doctor who works for the Veterans Administration considered a government employee?

Tanya Feke, MD
8 months ago

Medicare pays for services provided by private physicians in the community. They do not directly hire physicians to care for you.

The Veterans Administration, on the other hand, is a federal agency, and they hire physicians to work in their VA hospitals and clinics. As employees of the VA, those physicians are considered federal employees.

Romeo Rodriguez
9 months ago

Is a doctor who works for the Veterans Administration considered a government employee responsible for giving wrong Medicare advise?

Tanya Feke, MD
8 months ago

If a federal employee gives you misinformation about Medicare that leads you to delay enrollment, you may be able to request equitable relief. As federal employees, VA physicians fall under this category. You will need to appeal your case to Social Security to have any Part B late penalties removed or to have your Medicare benefits started retroactively. See the above article on how to go about making that appeal.

Lanette Fadely
8 months ago

A friend is under 65 and on Medicare Part A, he was a young man when it started, his parents who are now deceased declined the Part B because he is covered by the Indians. He is now 60 can he add Part B at this point? He only gets like $700 a month. Will being low income keep him having to pay the late penalty?

Tanya Feke, MD
8 months ago
Reply to  Lanette Fadely

Many people with low incomes turn to Medicare Savings Programs to help them pay for Part A and/or Part B premiums, deductibles, coinsurance, and copays. Anyone who qualifies for these programs will have their Part B late penalty cancelled. If your friend enrolls in Part B, they may be able to avoid Medicare late penalties if they meet the income and asset limits for one of these programs. They should reach out to their local Medicaid office to find out if they qualify.

Paul P
16 days ago
Awaiting for approval

My < 65 spouse has been on part A only since 1985 as she was on my insurance. I retired early and now social security is requiring she prove she had insurance since 1985. My employer records only go back to 1999. Insurance companies only go back to 2004. I have a gap from 85 to 99 for the part B penalty when she applies this coming January. The SS folks don’t seem to care that I can’t find records back to 1985 (should of kept the insurance cards). The employers, insurance companies, etc. say they are not obligated to retain data back that far. Also, there appears no way to appeal to a higher level at SS that would think the penalty is ludicrous. Your comment about HR giving bad advise is spot on.

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