How do I appeal my late enrollment penalty?

Dear Lee, 

Everyone has a right to file an appeal with the Social Security Administration (SSA) regarding their late enrollment penalty (LEP) determination. Since you had job-based coverage while you delayed enrolling in Parts B and D, you have good reason to appeal. Below you will find information about appealing the Part B and D LEP. 

Appealing Part B LEP 

If you meet any of the following reasons you can appeal to remove the Part B LEP or lower the penalty amount:  

• You had job-based insurance during some or all of the time period in question. 
• You were actually enrolled in Medicare Part B during some or all or the period in question. 
• You have a new Initial Enrollment Period (IEP). 
• You are enrolled in an MSP. 

Steps to Filing a Part B LEP Appeal: 

1. Gather your evidence 

• If you had job-based insurance: 
  • Call your former employer or plan and ask for a letter proving that you were enrolled in coverage. Make sure to attach this letter to your appeal form.  
• If you were actually enrolled in Medicare Part B during some or all or the period in question and being assessed in error  
  • You can include proof of that coverage, including Medicare Summary Notices (MSNs) showing payment for care, statements showing premiums paid, or other records. 

2. Follow the directions on the letter informing you about the penalty.  

• If you do not have this letter, you can use SSA’s request for reconsideration form. 

Appealing Part D LEP 

If any of the following reasons apply to you, then filing an appeal may result in the elimination or reduction of your Part D LEP: 

• You have Extra Help 
• You had creditable drug coverage during some or all of the time period in question 
• You had non-creditable drug coverage, but your or your spouse’s employer or insurer told you it was creditable or didn’t inform you that it was non-creditable 
• You were ineligible for a Medicare prescription drug plan (e.g., if you were living outside the U.S. or incarcerated) 
• You couldn’t enroll into creditable drug coverage because of a serious medical emergency 

Steps to Filing a Part D LEP Appeal: 

1. Gather your evidence:  

• If you had creditable drug coverage: 
  • Call your former plan and ask for a letter proving that you were enrolled in creditable drug coverage. Make sure to attach this letter to your appeal form.  
  • Your employer or union may also be able to confirm the fact that you had creditable drug coverage. 

2. Complete the appeal form you received from your plan and attach any evidence you have 

• If you don’t have an appeal form from your plan, you can also use this Part D LEP Reconsideration Request Form. 

3. Mail everything to C2C Innovative Solutions.  

The appeal deadline is 60 days from the date you received the letter informing you about the penalty. Be sure to follow the steps outlined above and file within 60 days. If you miss the 60 days deadline, you can write a letter explaining why you had good cause, or a good reason—like serious illness—that prevented you from appealing on time. Attach the letter to your appeal.  

While your appeal is being considered, be sure to pay the LEP to your plan along with your premium. If your appeal is successful, your plan will pay you back for the LEP payments you made while your appeal was pending. 

Hope this helps!  

– Marci