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How To Appeal the Medicare Part D Late Enrollment Penalty

If you don’t join a Medicare drug plan when you’re first eligible, you may have to pay a late enrollment penalty unless you had other "creditable prescription drug coverage," which means that your prescription drug coverage met Medicare’s minimum standards. In some cases, you have the right to ask Medicare to review your late enrollment penalty. This is called a "reconsideration." You might ask for a reconsideration if one of the following are true:
  • You don’t think Medicare counted all of your previous creditable prescription drug coverage.
  • You didn’t get a notice that clearly explained whether your previous drug coverage was creditable.

Who Can Ask for a Reconsideration?

You or someone you name to act for you (your representative) can ask for a reconsideration. If someone requests a reconsideration for you, he or she must send proof of his or her right to represent you with the request form. Proof could be a power of attorney form, a court order, or Form CMS-1696 (Appointment Of Representative).

How Do I Ask for a Reconsideration?

The reconsideration request form is sent with this notice. Complete the form. Mail it to the address or fax it to the number listed on the form within 60 days from the date on the letter you got stating you had to pay a late enrollment penalty. You should also send any proof that supports your case, like information about previous creditable prescription drug coverage. If you wait more than 60 days, you must explain why your request is late. Medicare will decide if you had good cause to send a late request.
What Do I Need to Include with My Late Enrollment Penalty (LEP) Reconsideration Request?

  1. A completed, signed Late Enrollment Penalty (LEP) reconsideration request (keep a copy).

  2. Copies of information you believe may help your case.

  3. If you’ve named someone to act for you, a copy of the proof the individual can represent you.
NOTE: Do not send original documents.
Your Medicare drug plan will give you a reconsideration request form when it sends you the letter telling you that you have to pay a late enrollment penalty. Mail the completed form to the address, or fax it to the number listed on the form within 60 days from the date on the letter. You should also send any proof that supports your case, like information about previous creditable prescription drug coverage.

Reconsideration of a Late Enrollment Penalty (LEP) is processed by an Independent Review Entity (IRE) which is also known as a Qualified Independent Contractor (QIC). The IRE/QIC handling Late Enrollment Penalty Reconsiderations is:

MAXIMUS Federal Services
Medicare Part D QIC
P.O. Box 991
Victor, NY 14564-0991

Fax numbers: (585) 869-3320
Toll free fax: (866) 589-5241
Customer Service: 585-425-5300
Toll Free Customer Service: 877-456-5302

If you need more information about requesting a reconsideration of your late enrollment penalty, call your Medicare drug plan. You also may visit www.medicare.gov, or call 1-800-MEDICARE (1-800-633-4227) for help. TTY users should call 1-877-486-2048.
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