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sueschuld1 Posted January 2023

Penalty for part D lapse, anyone familiar with this?

My mother-in-law moved in with us "temporarily" when Covid started she went home for a few months but then returned to us. She is from NY, and we live in Michigan. Her part D coverage was stopped without written notice as she had been out of state more than 6 months. We did not get new coverage right away for many reasons but when we found out we didn't have to wait for open enrollment we signed her up immediately. We recently received a letter that she may be penalized for the REST OF HER LIFE due to lapse in drug coverage. We filed a grievance with the company that cut her off, but they pretty much said too bad. We have started the process to fight this, any advice? It's not that much $ but no one told us this would happen, including her insurance agent.

JoAnn29 Jan 2023
The penalty comes in, I thought, when u don't get part B when ur 65. A you do not pay for, B u do and it comes out of you SS. Never thought you had to have part D since its not gotten thru Medicare. Is a Medicare Advantage involved? If so that may be your problem. I agree, call Medicare directly to see what Moms rights are.

BarbBrooklyn Jan 2023
Get the book "Medicare for Dummies" and read it. Written in much easier to understand language and it has the important bits bolded.

Appeal the decision to Medicare directly.

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97yroldmom Jan 2023
Here is a link to Medicare.gov that explains how and when the penalty is figured and what recourse there is. The penalty is based on how many months she was off the program. As you mentioned, it isn’t very much.
There are a lot of little “Gotcha’s” for the elderly. It is a good idea to read the annual Medicare publication that she will get each year to familiarize yourself with any changes year to year.
If your MIL needs help paying for her meds, check into the “extra help” provision.

https://www.medicare.gov/drug-coverage-part-d/costs-for-medicare-drug-coverage/part-d-late-enrollment-penalty

Isthisrealyreal Jan 2023
No. The only penalty that I am aware of is not taking Medicare when you turn 65.

Could it be that the rates are higher in her new zip code? That happened to my dad on his drug plan.

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