Late enrollment penalty calculator

How does the Part B penalty work?

When you first become eligible, you have a seven-month Initial Enrollment Period around your 65th birthday month. If you don't sign up for Part B then, and you don't have group health coverage from your own or your spouse's current job, Medicare counts the months until you do sign up. Each full 12 months adds 10% of the standard premium. A 30-month gap is two full periods, so 20%. In 2026 that is 20% of $202.90, about $40.58 a month on top of your premium.

The penalty follows the standard premium, so it rises when the premium does, and you generally pay it for as long as you have Part B. Coverage that doesn't protect you from the Part B penalty includes retiree coverage, COBRA, Marketplace plans and VA health care. That matters for Texas public retirees: TRS-Care and ERS retiree coverage are retiree plans, not coverage from current work, and both expect Medicare-eligible retirees to have Part B. See TRS-Care, ERS retirees and Medicare, working past 65 and, for veterans and TRICARE users, veterans, TRICARE and military retirees.

How does the Part D penalty work?

The Part D penalty applies if, after your Initial Enrollment Period, you go 63 days or more in a row without a Medicare drug plan or other creditable drug coverage. Creditable coverage is drug coverage expected to pay at least as much as standard Part D; your employer, union or other plan sends a notice each year saying whether yours is. Keep those notices: they are your proof if Medicare later asks.

The penalty is 1% of the national base beneficiary premium for each full month without coverage. In 2026 the base premium is $38.99, so a 24-month gap adds 24% of it to your monthly drug plan premium: $9.36 before Medicare rounds it to the nearest 10 cents. The base premium changes every year, so the penalty does too. Buying medicines across the border in Mexico doesn't count as creditable coverage. More on drug plans is on Medicare Part D in Texas.

How can Texans get the penalties removed?

• Medicare Savings Programs. Texas Medicaid pays your Part B premium, and with QMB also your Medicare deductibles and coinsurance. In 2026 your countable resources must be no more than $9,950 for one person or $14,910 for a couple; your homestead and one car don't count. Apply at YourTexasBenefits.com or with Form H1200-EZ, and check your numbers with the savings programs screener. Read Medicare Savings Programs in Texas.
• Extra Help. If you are in a Medicare Savings Program, have full Texas Medicaid or get Supplemental Security Income, you get Extra Help automatically. Otherwise you can apply with Social Security. Its resource limit is higher than the savings programs' limit.
• Special Enrollment Periods. If you had job-based coverage from current work, you generally have eight months after that job or coverage ends to sign up for Part B without a penalty. See enrollment periods for this and other situations.

Sources

• Medicare.gov — Avoid late enrollment penalties
• Medicare.gov — Part D costs and the late enrollment penalty
• CMS — 2026 Medicare Parts A & B premiums and deductibles
• HHSC MEPD Handbook — Appendix IX, Medicare Savings Program information
• HHSC MEPD Handbook — B-3100, Application process (Form H1200-EZ)
• TRS — 2026 FAQs for TRS-Care participants with Medicare (PDF)

Frequently asked questions