Why Am I Paying More For My Medicare 2025 Part D Premium?

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By Toni King

Why Am I Paying More For My 2025 Part D Premium?

Dear Toni:
In December 2016, you assisted me and my husband Gary in leaving my employer’s
benefits. We enrolled into Medicare Part B with a Medicare Supplement and Part D prescription
drug plan with all beginning January 1, 2017.
The 2024 Medicare AEP is the ONLY year that we have changed from the original
Medicare Part D plan that we enrolled in for 2017 and both Gary and I have recently received
invoices by mail from the $0 premium Part D plan. Gary’s payment for 2025 is $110.40 and
mine is $344.40. I don’t understand why we don’t have a Part D premium that was stated on the
Medicare.gov website as a $0 premium for the same Part D plan that we enrolled in November
2024 for 2025.
Please explain what our Medicare Part D issue may be. Thanks, Tonya
Hello Tonya:
This week, I had a few Toni Says Medicare clients call regarding their new Part D plan
enrollments because some are finding issues with what Medicare declares as costs for what their
prescriptions will be in 2025. Sometimes, the costs are updated, and they can change as the year
progresses.
Your situation, Tonya, is different because you and Gary are having a premium issue
with a 2025 Part D plan with a $0 monthly premium. Let’s discuss what you and Gary should do
to solve your Medicare Part D issue, after what we learned in the conference call that you and I
had when we called Medicare’s 800 number at 800-633-4227:
1) Call your old Part D plan to verify if you were charged a Part D Late Enrollment
Penalty (LEP) by waiting more than 63 days to verify that you left creditable
prescription drug coverage when leaving employer’s benefits in January 2017.
2) If charged a LEP, then the Medicare representative advised you to contact Social
Security to appeal the Part D LEP because you had filed yours and Gary’s Social
Security forms to prove you both had employer’s benefits after turning 65 until
you enroll in Medicare.
3) If you need additional assistance solving this issue, I advise you to contact your
local Congressperson to assist with appealing the Part D issue.
Readers, the LEP (Late Enrollment Penalty) for Medicare Part D can be charged to you because:
1) You waited past 63 days, without confirming you had creditable prescription drug
coverage, upon leaving company benefits and you were older than 65 years and
90 days. Readers: Do not wait past 63 days to enroll in Medicare Part D upon
leaving company health insurance! (Tonya, this may be your situation.)
2) Your company prescription drug benefits (not health insurance) were not
“creditable” under Medicare rules.
3) You never enrolled in Medicare Part D at the time you enrolled in Medicare PartA and Part B when you turned 65 and now want to enroll.
The Medicare rule regarding leaving employer benefits is that once you are past 65 and
leaving employer’s group coverage with a “creditable” prescription drug plan, Medicare gives
you only 63 days, not 90 days, not 8 months, but less than 63 days to enroll in Medicare Part D
or a Medicare Advantage plan with prescription drug coverage.
Tonya, your late enrollment period (LEP) did not begin from the day you both left your
employer benefits, nor from your Medicare Part B start date. It began from the month that you
and Gary’s individual Medicare Part A began. Please advise me what you find out when
completing your Medicare voyage and what answers you discover.
Tonya, you’re not alone, because Medicare’s rules are confusing for most Americans.
Remember with Medicare…it’s what you don’t know that WILL hurt you!
If the maze of Medicare is confusing you, contact the Toni Says® Medicare team at 832-
519-8664 or [email protected] with your Medicare questions.