Medicare Part D covers approved prescription medications. Your premium for this coverage is included in the premium you pay for coverage through PHIP. When enrolling in a PHIP Medicare plan, you will automatically be enrolled in a Part D drug plan.
You are only allowed to be enrolled in one Medicare Part D program at a time. You will be completely disenrolled from PHIP if you enroll in a second Medicare Part D plan or Medicare Advantage plan, including your optional dental coverage. Once disenrollment has occurred, you may not re-enroll in PHIP, unless you experience a new enrollment opportunity.
Part D Income Related Monthly Adjustment Amount (Part D-IRMAA) is an assessment required by Medicare for individuals whose income is above the Medicare-defined income threshold and is enrolled in a Part D (prescription drug) plan. Under PHIP, you will have a Part D prescription plan. Social Security will notify and bill you if you are required to pay this additional premium.
In order to be eligible for PHIP coverage, you must pay your Part D-IRMAA, or Medicare will notify your plan and you will be disenrolled from PHIP entirely. For questions regarding Part D-IRMAA, please contact Medicare. Do not contact PHIP or the health plans regarding this mandate.
What is the Part D Late Enrollment Penalty (LEP)?
A person enrolled in a Medicare drug plan may owe an LEP if they went without Part D or creditable prescription drug coverage for any continuous period of 63 days or more after the end of their Initial Enrollment Period for Part D coverage.
The “LEP” (or “penalty”) is added to the person’s monthly Part D premium for as long as they have Medicare prescription drug coverage. The LEP amount changes each year, and the person will have to pay it each month as long as he or she has Medicare prescription drug coverage, even if the person changes his or her Medicare drug plan. The cost of the late enrollment penalty depends on how long the person went without Part D or creditable prescription drug coverage.
What is considered creditable prescription drug coverage?
Creditable prescription coverage is drug coverage that is expected to pay, on average, at least as much as Medicare’s standard prescription drug coverage.
How is the LEP calculated?
Medicare, not the plan, calculates the LEP when a person subject to the penalty first joins a Medicare drug plan. The LEP amount typically is 1% of the national base beneficiary premium for each full, uncovered month that the person didn’t have Part D or creditable coverage. The national base beneficiary monthly premium for 2023 is $32.74. The monthly penalty is rounded to the nearest $0.10 and added to the monthly Part D premium.
Because PHIP’s Part D prescription drug plan is included in your monthly medical premium, PHIP will adjust your monthly premium rate to include the additional penalty Medicare has imposed.
No late-enrollment penalties are assessed on Medicare beneficiaries who qualify for the Medicare Part D Extra-Help or Low-Income Subsidy (LIS) program.
You can also get information by visiting www.medicare.gov or by calling 1-800-MEDICARE (1-800-633-4227), 24 hours a day/7 days a week. TTY users should call 1-877- 486-2048.
Medicare Low-Income Subsidy is a government program for eligible individuals who have limited income. The Medicare low-income subsidy, also known as the Medicare Extra Help program provides assistance in paying the Part D monthly premium, annual deductible, coinsurance and copayments.
How to apply for Medicare Extra Help
To apply for the Medicare low-income subsidy, simply fill out an “Application for Extra Help with Medicare Prescription Drug Plan Costs” (SSA-1020) form with Social Security. You can apply and submit this form by:
After you submit your application, Social Security will review it and send you a notification in the mail if you are eligible.
To contact Medicare, please refer to Medicare Resource.