How does the penalty under Medicare part D work?

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My mother is 89 and has not need prescription coverage until recently? In the past she always paid out of pocket for her meds but now needs more costly prescription medicines. She has dementia and on arisept and namenda. I understand that Medicare Part D companies will charge her a penalty since she did not have prescription coverage since 65 when she became eligible for medicare. Is 65 the starting age. she is now 89. That is 24 years of penalty? Can someone explain how the penalty works and how much it is going to cost in addition to joining a plan and paying for the prescriptions? Thanks!

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429 helpful answers offers a good explanation of the penalty imposed if a person was eligible for Medicare but did not sign up for Part D coverage: "Medicare calculates the penalty by multiplying 1% of the "national base beneficiary premium" ($34.10 in 2016) times the number of full, uncovered months you didn't have Part D or creditable coverage. The monthly premium is rounded to the nearest $.10 and added to your monthly Part D premium." See the examples at the link above.
Expert Answer
4 helpful answers
The Part D penalty goes back to the inception of Part D, which was May 2006. So your mother has approximately 120 months of penalty, or about "double" what she would be paying (120% of the average premium in her area) if she had had a plan all along.

First, remember that your mom has "saved" money all these years by not having a Part D plan, so hopefully that makes the penalty a bit easier to swallow. In addition, depending on her financial situation, she may not be subject to the penalty. Her medical condition qualifies her for Home and Community-Based care through Medicaid.

You can see information on Part D and the penalties, In addition, a SHIP counselor at your local senior center can assist. If your state has a State Pharmaceutical Assistance program, she may be eligible to enroll immediately (also true if she is relatively low-income.)

I would do a lot of investigation before enrolling a dementia patient in an HMO. I would want to make sure that they had a full complement of specialists that she needed. Again, a Medicaid Waiver program may be her best choice.
This is the first time that I have heard of a penalty under Medicare Part D, so will be interested to see what others have too say.

The only penalty I am aware of is under Medicaid. When applying for that program there is a review of finances for up to five years. Any money or property given as gifts or donations will be scrutinized. The penalty is equal to the gifted amount.
My father-in-law, a farmer, (Mr. Miser) thought the Medicare Advantage program wasn't paying for himself after he was on it for a year and decided to cancel his Medicare Advantage insurance. Fast forward a year. Discussing taxes with CPA/Attorney in rural, farming community. Mentioned f-i-l cancelled Medicare Advantage. CPA/Attorney reamed f-i-l for doing that. (LOL!!!)

I signed f-i-l up for Medicare Advantage program ASAP. We now have to pay a penalty of about $25.00/month for the rest of his life. Fast forward to now. now f-i-l is 88 years old, has Chronic Kidney Disease with Anemia Stage 5, dementia and a whole host of problems. One, just one, shot of Arenesp for CKD is $5000.00!!! He need this every month!!! Thank all the deities in heaven and everywhere else that he is back on his Medicare Advantage insurance, even with the penalty.

Bottom line.....get the insurance and pay the penalty if you have to. Better to sign up for it when you are first eligible. Your future self will thank you.
My understanding is that when it is time to review. October I think it is she can switch to an HMO AND GET PART d. However it does not cover the entire prescription.there is a coPay until she has reached 4,000 out of pocket unless her income is low enough and assets not including a home then she could get the 4,000 covered by state assistance without having full Medicaid. At least that is what my mom did Check with Medicare and your state assistance program. We are in Florida
There is an expert you can consult for free. Healthcare Connect show on Doctor Radio out of Langone Medical Center at NYU. The show airs live Thursdays 12-2 EST on satellite radio serius XM channel 110.
You can also go to the website and email your question just as you stated it here (very clearly stated). They will get back to you at no charge. I have my own question for you; will those two medications make a difference in your moms quality of life. Good luck.
According to the government website in the above post yes she will have a stiff monthly penalty for not signing up when she first qualified at age 65. The calculation will give u an idea of the amount which will be around $100 a month if my math is correct. Now does your mom perhaps qualify for medicaid? If so she could apply for that as her secondary insurance. So many people do not know about the penalities for medicare part C and D and get caught. We just had this happen to a sibling of mine, he was healthy took no meds thought I dont need that ins, then boom he had heart blockage pacemaker the works. Now he will have to pay the penalty, thank goodness its only for a year of non coverage. I wish you the best and hope there is some way she can get around this. Let us know what happens as it will help to inform others.

i was shocked when i called medicare to see what i should expect when i turn 65. i was told that i would have to pay for 20% of hospital and god knows what??? 20% of bills from hospital stays or anything else is astr0nomical!! anyway...i joined humana hmo...and hardly pay for anything!! i know this because my father takes 8 medications a day...both parents in and out of hospitals for last 10 years...and never paid for anything! go figure! but i always ask for generic drugs!!

i will have medicare...BUT...with the pay almost nothing...without HMO you pay 20% of everything!

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