I was first eligible for Medicare 17 years ago and had Part D with extra help coverage for 15 of those years, including 2024, however, last year I signed up for a new Advantage Plan and I did not notice it did not have Part D coverage included. Tow months later I was in the hospital for two days (colonoscopy and heart tests performed. Most of that was covered and I did not notice any prescripions/drugs not being covered (I went through the ER so maybe that was the difference?), but I was given 3 prescriptions upon release and found out that I didn't have Part D coverage when I went to fill them. I thought the lack of coverage was because I had changed plans and the coverage was somehow dropped, not ever thinking it was my own fault. Fast forward to last week while I was investigating plans to see if we still had the best coverage and THEN discovered WHY I had no Part D coverage. So, my question is: Since I HAD part D coverage for many years, will there still be a penealty when I either find a plan WITH Part D coverage? What happens if I don't sign up at all and 'foot the bill' for prescriptions, which I rarely require?
You can compare MA plans in your area at medicare.gov then go to find a plan
1. Does a Part D late-enrollment penalty apply?
Maybe — but probably small or possibly none depending on what counts as “creditable coverage.”
The official rule...
Medicare assesses a Part D penalty if you go 63 days or more in a row without:
Part D coverage, or
“Creditable” drug coverage (coverage that’s at least as good as Medicare Part D, such as from the VA, employer, or retiree plan).
The penalty is:
1% of the “national base beneficiary premium” ($34.70 in 2025) × the number of full, uncovered months you lacked creditable coverage.
That amount is added to your Part D premium permanently once you enroll again.
In your case
If the gap between when your prior Part D coverage ended and your new drug coverage begins is less than 63 days, ✅ no penalty.
If it was more than 63 days, Medicare will calculate a small penalty (for example, a 4-month gap = 4% of $34.70 ≈ $1.39 per month).
If you had Extra Help (Low-Income Subsidy) for any part of that time, note:
Extra Help recipients do not pay the Part D late-enrollment penalty while the subsidy applies.
So if you’re still eligible for Extra Help when you re-enroll, the penalty is waived.
2. When can you fix this?
You can enroll in a new plan that includes Part D:
During the Annual Election Period (Oct 15 – Dec 7),
or
During a Special Enrollment Period (SEP) if you qualify (for example, if you had Extra Help or Medicaid).
If you have Extra Help, you can change plans once per quarter in the first three quarters of each year.
3. What if you decide not to re-enroll in Part D?
You can simply pay for your prescriptions out of pocket. However:
You’ll have no coverage for future prescriptions, including very expensive ones (e.g., heart meds).
If you later change your mind and want Part D, you’ll have to wait until the next enrollment window and possibly owe the penalty (unless you regain Extra Help).
Recommendations:
Check whether you still have “Extra Help.”
If yes, there’s no penalty, and you can enroll in a new plan right now.
Call 1-800-MEDICARE or visit Medicare.gov to confirm your coverage gap dates.
They can tell you if a penalty applies and your exact “creditable coverage” history.
Compare new Advantage plans that include Part D (or stand-alone Part D plans if you prefer Original Medicare).
Document your coverage history in case Medicare questions your continuous coverage.