Información importante sobre las Multas por Inscripción Tardía
If you received a notice about a late enrollment penalty (LEP) from Wellcare, you’re in the right place. As your prescription drug provider, our priority is to ensure you have access to your medications. This page explains what the penalty is, why it happens, and what you can do next.
On this Page
- Understanding Your Late Enrollment Penalty
- Why We May Need More Information From You
- Paying Your Late Enrollment Penalty
- If You Disagree With the Penalty
- After Medicare Reviews Your Case
- Need More Help?
¿Qué es una Multa por Inscripción Tardía (LEP)?
Centers for Medicare and Medicaid (CMS), requires all Medicare members to have prescription drug (Part D) coverage. If you went 63 or more consecutive days without Part D or other qualifying drug coverage after your initial enrollment period ended, Medicare requires us to add a Late Enrollment Penalty to your monthly premium.
Even if your monthly premium is $0, the penalty is still owed. Leaving it unpaid can result in loss of your drug coverage. | Return to top
What counts as qualifying coverage?
- Plan de medicamentos con receta de Medicare (Part D);
- Un Plan Medicare Advantage (Part C) (como un HMO o PPO) u otro plan de salud de Medicare que ofrezca cobertura de medicamentos recetados de Medicare o
- Cobertura acreditable de medicamentos recetados (empleador o sindicato actual o anterior, TRICARE, Servicio de Salud Indígena, Departamento de Asuntos de Veteranos, CHAMPVA o cobertura de seguro médico).
*If you had any of this coverage but didn't report it when you enrolled, you may be able to have the penalty reduced or removed. See the dispute options below.
¿Cómo sabré si debo una multa?
- Le enviaremos una carta por correo si tiene una multa. Por lo general, tendrá que pagar esta multa mientras tenga un plan de medicamentos de Medicare.
¿Por cuánto tiempo pagaré esta multa?
- You’ll usually pay the penalty for as long as you have Medicare drug coverage. This also applies to plans with a $0 monthly premium..
- This is not a one-time fee. Your LEP is a lifetime penalty and continues even when you change Medicare plans.
- La LEP puede finalizar en circunstancias específicas, incluido en el momento que cumple 65 años (si se le había asignado una LEP en relación con los beneficios de Medicare antes de esa edad) y cuando sea elegible para la Ayuda Adicional (Extra Help) (también conocida como Subsidio por Bajos Ingresos).
¿Por qué aumentó el monto de mi LEP?
- LEP amounts will change each calendar year in accordance with the Centers for Medicare and Medicaid (CMS) guidelines. Be sure to review your coupon book or AutoPay/EFT statement for the new amount. If you have a Social Security or Railroad deduction, you may view your new amount in your member portal.
- CMS determines the national plan premium average each year, which is used to calculate the amount of the monthly LEP. Learn more about how it’s calculated (PDF).
¿Cómo puedo proporcionar información con respecto a la cobertura anterior de la Parte D?
Cuando se inscribe en un plan de la Part D, es importante que proporcione información sobre la cobertura anterior si no se inscribe al cumplir los 65 años.
- If you are within the 60 days of the date on the letter advising of LEP, you can provide us with this information by completing the Declaration of Prior Prescription Drug Coverage form online. You can also complete the Declaration of Prior Prescription Drug Coverage form that was mailed to you when we provided notification of the LEP, or by calling Member Services.
- If it has been more than 60 days or you disagree with the LEP decision you can complete and submit the Part D LEP Reconsideration Request Form below.
Note: If more than 60 days have passed, write the reason for the delay on a separate sheet and include it with this form. Declaration of Prior PDP Coverage Form (PDF)
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Why am I getting repeated requests for attestation information?
- There are several reasons that it can take some time to resolve your request to remove (or reduce) your LEP. It is important to make sure that the information is complete and everything required is provided. Did you sign the form? Did you provide coverage information for the entire period listed in the letter that was sent? Did you list prescription plans or services (such as Good Rx) that do not satisfy Medicare requirements for creditable coverage?
¿Tengo que pagar la LEP aunque no esté de acuerdo con ello?
- Even if you disagree with the penalty, you should keep paying it while your request is being reviewed. If you do not pay it, you could lose your prescription drug coverage. You can complete an attestation form if you disagree with the late enrollment penalty. | Return to top
Si tengo Extra Help, ¿aún adeudo el pago de la multa?
- If you receive Extra Help, you may be subject to an LEP, depending upon when you enroll into your plan. In most cases, when you qualify for Extra Help, also known as a Low-Income Subsidy, an LEP is not charged.
¿Qué pasa si no tengo muchas recetas y solo quiero pagar directamente en lugar de tener un plan de medicamentos con receta?
- Según la ley federal, CMS requiere que los beneficiarios elegibles para Medicare tengan un plan de medicamentos recetados calificado. Si posteriormente se inscribe en un plan de medicamentos recetados, se le aplicará la LEP por todas las brechas en la cobertura (más de 63 días).
- Los planes de medicamentos de bajo costo que tienen cobertura acreditable están disponibles en la mayoría de las regiones, y esto puede resultar preferible a pagar una multa elevada en el futuro. Por ejemplo, una brecha de 12 meses en la cobertura dará como resultado una multa de aproximadamente $4.00 por mes, mientras que si espera 5 años para inscribirse, la LEP será de más de $20.00 por mes.
¿Qué sucede si no estoy de acuerdo con la LEP?
If you disagree with the Late Enrollment Penalty, you can ask Medicare to review the decision. You may need to provide proof that you had past prescription drug coverage.
- You can send information about your prior prescription drug coverage online, by phone, or in writing.
- If you send it in writing, complete the form listed in your LEP letter and return it to the address or fax number on the form. This must be done within 60 days from the date on the letter telling you that you owe an LEP.
- Please include any proof you have, such as a notice of creditable drug coverage from an employer or union plan.
- Copies of the Prior PDP Coverage Form and the Part D LEP Reconsideration Request Form are linked at the bottom of this page. These forms were also included with the letter you received.| Return to top
Which form should I use?
- Use the Declaration of Prior PDP Coverage Form if you are sending information about past prescription drug coverage within 60 days of your LEP letter.
- Use the Part D LEP Reconsideration Request Form if you missed the 60-day deadline or disagree with the LEP decision.
Who make the decision about my penalty?
- C2C is an agency that works on behalf of CMS to review and determine outcomes for redetermination requests. You can review the status of your request by calling 1-(833) 919-0198 (Toll Free), (TTY: 1-800-725-9216), between 9:00 AM to 6:00 PM (EDT), Monday through Friday.
You can also reach out to C2C about your LEP Reconsideration by:
- Fax: 1 (833) 946-1912
- Mail:
- UPS / FedEx ONLY:
C2C Innovative Solutions, Inc.
Part D QIC
301 W. Bay St., Suite 1110
Jacksonville, FL 32202
- United States Postal Service (USPS):
C2C Innovative Solutions, Inc.
Part D Drug Reconsiderations
P.O. Box 44166
Jacksonville, FL 32231-4165
¿Qué tan pronto recibiré una decisión de reconsideración?
- Las decisiones de reconsideración se toman en un plazo de 90 días. Todas las decisiones están sujetas a la aprobación de Medicare. No influimos en la decisión final.
- C2C may contact you during your appeal process to request additional information, it’s important that you respond with the information timely.
- For updates contact C2C directly at 1-(833) 919-0198 (Toll Free).
What happens if Medicare decides my penalty is wrong?
- Medicare le enviará una carta con la decisión tomada. Si se revierte, eliminaremos o reduciremos la LEP y le enviaremos una carta con el importe correcto de la prima y una explicación sobre si recibirá un reembolso.
- In many cases, the decision results in a partial reduction in the amount of LEP that you are required to pay. | Return to top
¿Qué sucede si Medicare decide que la multa es correcta?
- Si Medicare decide que la multa por inscripción tardía es correcta, se le enviará una carta explicando la decisión y usted deberá pagar la multa.
¿Tiene otras preguntas? ¡Estamos aquí para ayudarlo!
- You can chat live with a representative in our Member Portal or call us at 1-888-550-5252 (TTY: 711). Representatives are available to take your call Monday-Friday from 8 a.m. to 8 p.m. Between October 1 and March 31, representatives are available Monday-Sunday, 8 a.m. to 8 p.m. | Return to top
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