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Trusted Contributor

Medicare Part D

I recently lost insurance coverage through spouse which I’d had until last month due to business closing. During those years of employment, I had both primary medical and rx through employer’s insurance plan; now I’ve applied for Medicare, a supplement and Rx plan and received a letter from new plan Rx insurance saying Medicare had no evidence I’d had Rx coverage and I will be penalized for almost five years for failing to have Part D. I tried calling the number on the notice but the phone person spoke very broken English and kept repeating one thing, “Medicare says you didn’t have Rx coverage, you owe penalty”. I have only ten days to respond with proof I was covered and can’t obtain any of that proof until spouse’s former employer responds to my request which means they need to get their carrier to show proof then I was told that even with proof I can still be penalized and must pay the five years worth of penalties! I have heart condition and my bp these past two days is way too high. There is no help for seniors where I live and the slow nail service, waiting on former employer to act and trying to beat Medicare’s clock has me sick. I am lost as to how to obtain proof dince my spouse received letters for taxes showing Rx coverage but I never received any as dpouse’s dependent on policy. Am I screwed or what? I really need help with this. 

Trusted Social Butterfly

Can you visit a local SSI office..Do you have any pay stubs or receipts that show reductions or income tax forms that you made showing any payments for medical expenses? Contact your local tv station if they have a help line or perhaps your state representative for help or information as how to prove your case...I am a penalize payer and believe this is an injustice. If your penalize I feel it should be just for the time that elapsed not for life..Even a prisoner  gets to go to the parole board and sometimes they get off with a lesser sentence for good behavior or an injustice that was done...

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Honored Social Butterfly - 3 ways to avoid the Part D late enrollment penalty


You have got to get that verification of creditable coverage either from the employer or the actual prescription drug plan which you were on  under the employer health insurance.  


This is what you should have been getting each year while under the employer prescription drug plan. - Notice of Creditable Coverage


Perhaps contact the actual plan provider for a statement that you were covered for prescription drug coverage - Medicare will have to determine if that is enough for creditable coverage.


From a recent conversation on this subject on Reddit/Medicare: Part D penalty

Under the Medicare Modernization Act, employers are required to provide a “creditable drug coverage letter” to anyone enrolled in the company’s group plan that is over age 65. The problem in that there is no monetary penalty if the employers don’t comply, so many do not.


Once you have the “creditable drug coverage letter or letters”. You will need to google “Medicare Part D Appeals” and find the private vendor that handles these. You will fill out an appeal form, send them copies of the letters and they should be able to reduce or eliminate the Part D Late Enrollment Penalty based on the number of month that can be documented with the “creditable drug coverage” letters from the form employer or employers. If you disagree with your late enrollment penalty

You should have gotten the form with the letter of notification.


Are you working with a Medicare insurance broker or agent for your new part D plan?  If so, they may be able to help you get the info needed to file the appeal.

OR just keep calling the employers health plan for the documentation which you need to offset this Part D penalty (hopefully, it was creditable coverage)



It's Always Something . . . . Roseanna Roseannadanna
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Trusted Contributor

It was quite ‘creditable’, insurance was top-rate major medical plan and employer used CVS Rx plan. A proof of insurance was sent for tax purposes each year to my spouse whose policy i was under but, I personally never received such a letter and those he rec’d he’s destroyed. I called the former Rx insuror and was told to contact his former employer but this has yielded no results. Even if I could get this info, I can’t meet the 10-day mandatory response time as i only now have eight days left and the HR dept. where he worked is permanently closed AND they refuse to let me just copy the old insurance cards I have. The senior center that aids seniors in applying for insurance in retirement said they can’t help me because I need proof. Why can’t my drugstore print out their record that shows Medicare my prior insurance I got Rx under? I can’t take this stress and I don’t have money to pay penalties of a couple thousand dollars which is what I’d owe. Ten days given to respond AND even if I could they say they could still penalize me, at their discretion! My prior Rx plan was top shelf unlike this over private mandatory Part D and it’s damned doughnut hole.

Thank you for answering.

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Honored Social Butterfly

Didn’t you personally have an account number with the plan name on it.  That’s the insurer that gets you the info.  It isn’t the insurer for the medical plan they are looking for so much as the employer prescription drug plan name and number.  I guess sometimes they could be the same.   “Creditable” only has to do with the prescription drug plan -  “employer CVS RX plan” doesn’t say much in determining if the coverage was creditable to Medicare.


Get the pharmacy to give you the name of the plan they used to fill your RX and your number too - that way you have a starting point to get the info.


Meeting the time limit would be good - but if you can’t, you can’t - submit it when you get it.  


Are you low income where some of your Medicare cost is subsidized by the government?  If so, just get that program and the penalty doesn’t matter.  How did you get your current Medicare Prescription Drug plan - is it free standing or is it within a MA plan (MAPD). If you worked with an agent or broker, maybe they can help you get the info you need to get it to Medicare for determination.


How many months are they saying you will be penalized?

How many months were you without any coverage? Part D Late Enrollment Penalty

It's Always Something . . . . Roseanna Roseannadanna
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