top of page

Medicare LEPs, ACA, Fraud

Updated: May 8

We have three subjects that we want to put in front of you today:

1. Medicare: Late Enrollment Penalties (LEP)

2. Affordable Care Act

3. Fraud

First, Late Enrollment Penalties. You could receive an LEP for Part A, Part B, or Part D. Part D is where most people become aware of LEPs. LEPs come into play when beneficiaries do not sign up for Medicare when they become eligible.

Let’s talk about Part A, Original Medicare hospital insurance, first. If the beneficiary does not qualify for premium free Part A and you don’t buy Part A when you are first eligible, you may be charged a penalty equal to twice the number of years that you didn’t sign up. So, if you were eligible for 5 years but did not sign up you may pay the 10% penalty for 10 years.

There are exceptions to the above statement. The exception used most often is that the beneficiary was covered by employer group coverage based on their or their spouse’s current employment. This is an example of one exception.

Part B, out-patient insurance, has a penalty that is calculated similar to Part A. If the beneficiary is assigned a LEP, it will most likely be paid every month as long as the beneficiary keeps Part B. Again, there are exceptions.

Part D, prescription drug insurance. Beneficiaries may owe a penalty if, at

any time after their initial enrollment period, there is a period of 63 consecutive days or more when he/she did not have credible drug coverage. As true for Parts A and B, there are exceptions for Part D. Please notice the phrase “credible coverage”, it is very important.

Also, you may appeal any decision made by Medicare. If you would like clarification, contact your Medicare agent, call Lynn or Nan, or, contact Medicare directly.

The Affordable Care Act has an additional enrollment period this year! The enrollment period ends August 15. If you have questions, call your healthcare agent, or, call us!

As we have mentioned before, fraud is a problem, especially for those over 65. These fraudsters seem to think we all stopped thinking when we turned 65. Please be aware that unscrupulous people can purchase lists of names that may include your address, phone number, age, and maybe a guess at your annual income. If you receive a call or text saying there is something wrong with your Amazon account, or any other account, don’t call back on the number they provided. Call the number you have for the account in question. We are receiving calls, texts, and emails regularly from people who are trying to commit fraud, do not help them!

Have a great month!

4 views0 comments

Recent Posts

See All

Medicare Season is Almost Here!

News Flash: Beginning October 1, agent/brokers are required by CMS to notify beneficiaries that all phone calls regarding Medicare will be recorded. Incredible! October 1 begins the 2023 Medicare se


Commenting has been turned off.
bottom of page