Medicare 2026

How San Francisco Residents Avoid Medicare Late Fees

Missing your Medicare sign-up window can cost you for the rest of your life. That's the hard truth behind late-enrollment penalties for Part B (doctor visits and outpatient care) and Part D (prescription drugs). The good news for San Francisco residents: these penalties are almost always avoidable if you know the rules and the deadlines.

How the Part B late penalty works

If you don't sign up for Part B when you're first eligible — usually the seven-month window around your 65th birthday — you may owe a penalty when you eventually enroll. The penalty is 10% added to your Part B premium for each full 12-month period you could have had Part B but didn't. In most cases, you pay that higher premium for as long as you're enrolled in Part B.

The penalty is not a one-time fee. It's a permanent addition to your monthly bill, which is why even a short delay matters.

How the Part D late penalty works

The Part D penalty applies if you go 63 days or more in a row without "creditable" prescription drug coverage after you're first eligible for Medicare. Creditable coverage means drug coverage that is expected to pay, on average, at least as much as standard Medicare Part D.

The math: Medicare multiplies 1% of the "national base beneficiary premium" by the number of full months you went without creditable coverage, rounds to the nearest 10 cents, and adds that amount to your monthly Part D premium. Like the Part B penalty, it typically sticks with you for as long as you have Part D.

How to avoid the penalties

Most people can steer clear of both penalties with a little planning:

• Enroll during your Initial Enrollment Period. This is the seven-month window that starts three months before the month you turn 65 and ends three months after.
• Keep creditable coverage in writing. If you're delaying Part B or Part D because you have job-based insurance, TRICARE, or VA drug coverage, save the "creditable coverage" notice your plan sends each year. You'll need it later.
• Use your Special Enrollment Period. When you lose that other coverage, you generally have up to eight months to sign up for Part B without a penalty, and 63 days to join a Part D plan.
• Don't rely on COBRA or retiree coverage as a Part B substitute. These usually do not count as active employer coverage for Part B purposes, and many people get tripped up here.

What this means locally in San Francisco

San Francisco is in San Francisco County, where Medicare plan availability — including stand-alone Part D drug plans and Medicare Advantage plans that include drug coverage — is set at the county level. That means the menu of plans you can choose from to satisfy Part D is based on your county of residence, not your ZIP code alone.

You can compare available plans, check whether your drugs are covered, and confirm a plan is "creditable" using the Plan Finder at medicare.gov.

Key 2027 dates and figures to know

A few program-level numbers can help you plan:

• Annual Enrollment Period: October 15 through December 7, for changes that take effect January 1.
• Medicare Advantage Open Enrollment: January 1 through March 31.
• Part D out-of-pocket cap: $2,100 in 2026 and $2,400 in 2027.
• Part D maximum deductible: $615 in 2026 and $700 in 2027.
• Coverage gap: The old "donut hole" is gone as of 2025; Part D now has three phases.
• IRMAA surcharges: Begin above $109,000 in income for a single filer in 2026.

These figures come from CMS and medicare.gov and apply nationwide, including in San Francisco.

Where to get personalized help

Penalties are calculated based on your individual history, so a quick call to a neutral source is worth the time. In California, the State Health Insurance Assistance Program is called HICAP (Health Insurance Counseling and Advocacy Program) and offers free, one-on-one counseling. You can also call 1-800-MEDICARE (1-800-633-4227) or visit medicare.gov for official guidance.