Why am I paying more for my 2025 Part D premium?

on Jan 2, 2025

Dear Toni:

In December 2016, you assisted me and my husband Gary in leaving my employer’s benefits. We enrolled into Medicare Part B with a Medicare Supplement and Part D prescription drug plan that began on January 1, 2017.

The 2024 Medicare AEP is the ONLY year that we have changed from the original Medicare Part D plan that we enrolled in for 2017, and both Gary and I have recently received invoices by mail from the Part D plan. Gary’s payment for 2025 is $110.40, and mine is $344.40.

I don’t understand why we have a Part D premium that was stated on the Medicare.gov website as a $0 premium for the same Part D plan that we enrolled in November 2024 for 2025.

Please explain what our Medicare Part D issue may be. Thanks, Toni.

--Tonya, Galveston, Texas

Hello Tonya:

This week, I had a few Toni Says Medicare clients call regarding their new Part D plan enrollments because some are finding issues with what Medicare declares as costs for what their prescriptions will be in 2025. Sometimes, the costs are updated, and they can change as the year progresses.

Your situation, Tonya, is different because you and Gary are having a premium issue with a 2025 Part D plan with a $0 monthly premium. Let’s discuss what you and Gary should do to solve your Medicare Part D issue, after what we learned in the conference call that you and I had when we called Medicare’s 800 number at 800-633-4227:

1. Call your old Part D plan to verify if you were charged a Part D Late Enrollment Penalty (LEP) by waiting more than 63 days to verify that you left creditable prescription drug coverage when leaving employer’s benefits in January 2017.

2. If charged a LEP, then the Medicare representative advised you to contact Social Security to appeal the Part D LEP because you had filed yours and Gary’s Social Security forms to prove you both had employer’s benefits after turning 65 until you enrolled in Medicare.

3. If you need additional assistance solving this issue, I advise you to contact your local Congressperson to assist with appealing the Part D issue.

Readers, the LEP for Medicare Part D can be charged to you because:

1. You waited past 63 days, without confirming you had creditable prescription drug coverage, upon leaving company benefits and you were older than 65 years and 90 days. Readers: Do not wait past 63 days to enroll in Medicare Part D upon leaving company health insurance! (Tonya, this may be your situation.)

2. Your company prescription drug benefits (not health insurance) were not “creditable” under Medicare rules.

3. You never enrolled in Medicare Part D at the time you enrolled in Medicare Part A and Part B when you turned 65 and now want to enroll.

The Medicare rule regarding leaving employer benefits is that once you are past 65 and leaving employer’s group coverage with a “creditable” prescription drug plan, Medicare gives you only 63 days, not 90 days, not 8 months, but less than 63 days to enroll in Medicare Part D or a Medicare Advantage plan with prescription drug coverage.

Tonya, your late enrollment period (LEP) did not begin from the day you both left your employer benefits, nor from your Medicare Part B start date. It began from the month that you and Gary’s individual Medicare Part A began. Please advise me what you find out when completing your Medicare voyage and what answers you discover.

Tonya, you’re not alone, because Medicare’s rules are confusing for most Americans. Remember with Medicare, it’s what you don’t know that WILL hurt you!

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Toni King is an author and columnist on Medicare and health insurance issues. She has spent nearly 30 years as a top sales leader in the field. For a Medicare checkup, call the Toni Says call center at (832) 519-8664 or email info@tonisays.com regarding your Medicare plans and options. Toni Says Medicare Survival Guide Advanced edition is available at www.tonisays.com.