What is Medicare’s “Famous” Part B penalty ?

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On Thursday, Nov. 20, at 4 p.m. CST, Toni will host a “2026 Confused About Medicare” Zoom online nationwide workshop to explain how to enroll in Medicare the right way as well as changes for 2026 Medicare’s Part D Prescription Drug plans. Visit www.tonisays.com to register.

 Toni,

I need your help! I have discovered that my mother, Sarah, who is 67, never enrolled in Medicare Part B or a Part D prescription drug plan when she turned 65. She enrolled in Medicare Part A, which doesn’t have a premium so that she could pay her monthly bills. A friend told my mother that if she did not go to the doctor, my mother could wait to enroll in Medicare Part B when she had a health issue.

Last month, my mother was diagnosed with colon cancer and received a bill from the cancer facility for outpatient care because Medicare has denied her cancer claim since she is not enrolled in Medicare Part B. I contacted the local Social Security office and was told that she must wait until January 1 to enroll in Medicare Part B during Medicare’s General Enrollment Period. The Social Security agent said that my mother had missed her “window of opportunity” by not enrolling when she turned 65 and will receive a Medicare penalty. Please advise me what I can do to help my mother. Thanks, Toni.

--Marianne

Oh my, Marianne:

Your mother, Sarah, has an extremely serious Medicare issue! She will have to enroll during Medicare’s General Enrollment Period (GEP), which is from January 1 to March 31of each year for those who have never enrolled in Medicare. And she will receive the “famous” Part B penalty for the rest of her Medicare life.

Beginning January 1, 2023, Medicare’s General Enrollment Period January 1-March 31 rules changed that helps Americans who had not enrolled in Medicare when turning 65. Now, when you enroll in January, February or March, your Medicare Part B will begin on the first day of the following month. Wait past March 31 to enroll in Medicare and your Medicare enrollment time will be delayed until January 1 of the next year, receiving a higher Part B penalty that will go all the way back to the month you turned 65.

The Medicare Part B penalty that Sarah will receive when enrolling during Medicare’s GEP is a 10% penalty for each 12-month period or year that she did not enroll. Her penalty will be 20% (2 years times 10%). The penalty stays in effect for the life of the Medicare beneficiary’s Medicare coverage.

Marianne, I do have one good thing to tell you and your mother because now is Medicare’s Open Enrollment Period (OEP) which is from October 15-December 7. This enrollment period is when Sarah can enroll in a Medicare Part D plan that begins January 1, helping with her cancer diagnosis. She may receive a Part D penalty for not enrolling in a Medicare Part D plan when her Medicare Part A began. During Medicare’s OEP, she cannot enroll in a Medicare Advantage Prescription Drug Plan (MAPD) because she’s not enrolled in Medicare Part B. After January 1, when Medicare’s General Enrollment Period (GEP) begins and she is enrolled in Part B, then your mother can enroll in an MAPD plan if she chooses. During Medicare’s GEP, she can also enroll in a Medicare Supplement without having to answer underwriting questions for a 6-month window because her Part B has just started.

Medicare enrollment periods are listed below:

• Medicare Initial Enrollment Period: 7-month window that begins 3 months before one turns 65, the month turning 65 and 3 months after one turns 65.

• Special Enrollment Period: Enroll after one is 65 and 90 days when delaying Medicare Part B due to working full time with employer health insurance benefits. There is an 8-month window for signing up for Medicare Part B without receiving a Part B penalty when employment or employer health insurance ends whichever happens first.
• General Enrollment Period: January 1-March 31 every year, when one has not enrolled in Medicare and can enroll in Medicare beginning the first of the next month and will receive a Medicare penalty.            

There are millions of Americans receiving Medicare Part B and/or Part D penalties because they did not enroll in Medicare at the right time. Remember with Medicare, what you don’t know WILL hurt you!

On Thursday, Nov. 20, at 4 p.m. CST, Toni will host a “2026 Confused About Medicare” Zoom online nationwide workshop to explain how to enroll in Medicare the right way as well as changes for 2026 Medicare’s Part D Prescription Drug plans. Visit www.tonisays.com to register.

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