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Part D Late Enrollment Penalty
The Part D late-enrollment penalty is 1% of the national base beneficiary premium for each month you went without creditable drug coverage. With a 2026 national base beneficiary premium of $38.99, each month without coverage adds about 39 cents — roughly $4.68 a month for every year you went without, permanently.
How it's calculated
Medicare counts the full months you went without creditable drug coverage after becoming eligible, multiplies by 1% of the national base beneficiary premium ($38.99 in 2026), rounds to the nearest 10 cents, and adds it to your premium for as long as you have Part D. See Medicare.gov.
What it costs over time
| Months without coverage | Added per month (2026) |
|---|---|
| 12 | $4.68 |
| 24 | $9.36 |
| 36 | $14.04 |
| 60 | $23.39 |
The base premium changes annually, so the penalty amount moves with it.
What counts as creditable coverage
Coverage expected to pay at least as much as standard Part D — typically an employer or union plan, TRICARE, or VA drug coverage. Your plan must tell you each year in writing whether it's creditable. Keep that letter; it's your evidence.
The 63-day rule
A gap only triggers the penalty once it reaches 63 continuous days without creditable coverage after your Initial Enrollment Period. Shorter gaps don't count.
How to avoid it entirely
Enrol in a Part D plan when first eligible even if you take no medication — low-premium plans exist for exactly this — or keep documented creditable coverage. See Medicare.gov for help with costs; Extra Help recipients don't pay the penalty at all.
Estimates only
An estimate using published federal figures; your plan and Medicare determine the actual amount.
Not sure which of these fits you? A free 15-minute call with a licensed local advisor sorts it out — no pressure, and no cost to you. We do not offer every plan available in your area. For a complete list of every plan in your county, use Medicare Plan Compare or call 1-800-MEDICARE.
Questions, answered
How long does the Part D penalty last?
For as long as you have Part D coverage. It's recalculated annually against the national base beneficiary premium, so it can rise over time.
Does VA drug coverage count as creditable?
Yes. VA prescription coverage is creditable, so you can decline Part D without penalty — but it only works at VA pharmacies, which matters if you see community doctors.
What if I get Extra Help?
People who qualify for Extra Help don't pay the Part D late-enrollment penalty. If you've been paying one and later qualify, it stops.
Sources
- Medicare.gov — Part D costs
- CMS — Final CY2026 Part D Redesign Program Instructions
- Medicare.gov — Help with drug costs (Extra Help)
- SSA — Extra Help with Medicare drug costs
Figures are for 2026 and come from the official sources above. Plan-specific costs vary by county and carrier — confirm yours on Medicare Plan Compare or with a licensed agent.
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Content reviewed by Brian Penner, Independent Medicare advisor — no pressure.