Medicare 2026

How Part B and Part D penalties work in Elmhurst

ELMHURST, Ill. — Missing a Medicare deadline can cost you every month for the rest of your life. That's the hardest thing to explain about late-enrollment penalties for Part B (doctor visits and outpatient care) and Part D (prescription drugs): they don't just sting once. In most cases, they stick to your premium for as long as you have coverage.

The good news is these penalties are avoidable if you know when to sign up — and what counts as "creditable" coverage in the meantime. Here's how the rules work as you weigh 2027 coverage, and where Elmhurst readers can get free, unbiased help.

The Part B late-enrollment penalty

If you don't sign up for Part B when you're first eligible, and you don't have qualifying coverage from a current job, Medicare can add 10% to your Part B premium for each full 12-month period you could have had it but didn't.

That surcharge isn't a one-time fee. It's added to your monthly Part B premium for as long as you're enrolled in Part B — which, for most people, means the rest of their lives.

Your first chance to enroll is the seven-month Initial Enrollment Period around your 65th birthday: the three months before, the month of, and the three months after. Miss that window without other qualifying coverage, and you may have to wait for the General Enrollment Period (January 1 – March 31) to sign up.

The Part D late-enrollment penalty

Part D has its own separate penalty. If you go 63 or more days in a row without Part D or other creditable prescription drug coverage after your Initial Enrollment Period, Medicare can tack on a monthly penalty when you finally do enroll.

The Part D penalty is calculated as 1% of the "national base beneficiary premium" for every month you were eligible but uncovered. Like the Part B penalty, it's usually permanent, and it's added on top of whatever your drug plan's premium is.

"Creditable coverage" is a specific term. It generally means drug coverage that's expected to pay, on average, at least as much as standard Medicare Part D. Employer plans, union plans, TRICARE, and VA benefits often qualify — but you should get a notice of creditable coverage from that plan in writing each year. Save those notices.

Special Enrollment Periods can protect you

If you're still working at 65 and have health coverage through your job (or a spouse's job), you generally don't have to enroll in Part B right away. When that job-based coverage ends, you get a Special Enrollment Period — typically eight months — to sign up for Part B without penalty.

The same idea applies to Part D. If you had creditable drug coverage and then lost it through no fault of your own, you usually get a two-month window to join a Part D plan without a penalty.

The mistake we see most often: assuming COBRA or retiree coverage counts the same as active employer coverage for Medicare purposes. It usually doesn't. COBRA is not considered active employer coverage for the Part B Special Enrollment Period, and delaying past your Initial Enrollment Period while on COBRA is one of the most common ways people rack up a Part B penalty.

Key dates to keep on the fridge for 2027 coverage

• Initial Enrollment Period: Seven months around your 65th birthday.
• General Enrollment Period: January 1 – March 31 (for people who missed their initial window).
• Annual Enrollment Period: October 15 – December 7 (for changing Medicare Advantage and Part D plans).
• Medicare Advantage Open Enrollment: January 1 – March 31 (one switch allowed if you're already in a Medicare Advantage plan).

A few 2026 figures worth knowing while you're planning: the Part D maximum deductible is $615, and Part D out-of-pocket spending is now capped at $2,100 a year. The old coverage gap ("donut hole") was eliminated in 2025. Higher-income beneficiaries — generally single filers with income above $109,000 — may also owe IRMAA surcharges on top of standard premiums in 2026.

What this looks like in Elmhurst

Elmhurst is in DuPage County, where Medicare beneficiaries have a range of Original Medicare, Medicare Advantage, and stand-alone Part D options to choose from during open enrollment. Plan availability and specifics are set at the county level, not the city level, so two neighbors on the same street generally see the same set of plans.

If you're weighing whether a particular plan's drug coverage counts as creditable, or trying to figure out whether you owe a penalty already, don't guess. Illinois's Senior Health Insurance Program (SHIP) offers free, one-on-one counseling and doesn't sell anything.