Medicare 2026

Part B and Part D Late Fees: Rochester Medicare Rules

ROCHESTER, Minn. — If you're approaching 65 in Rochester, one of the most expensive mistakes you can make with Medicare has nothing to do with picking the "wrong" plan. It's missing an enrollment deadline. Late-enrollment penalties for Part B and Part D can follow you for the rest of your life — and most of them are avoidable once you know the rules.

Here's a plain-language guide to how the penalties work, who they apply to, and how to sidestep them.

What the Part B late-enrollment penalty looks like

Medicare Part B covers doctor visits, outpatient care, and many preventive services. If you don't sign up when you're first eligible — and you don't have other qualifying coverage — you may pay a permanent penalty on top of your monthly Part B premium.

According to the Centers for Medicare & Medicaid Services (CMS), the Part B penalty adds 10% to your premium for each full 12-month period you could have had Part B but didn't. And here's the part that catches people off guard: that penalty usually lasts as long as you have Part B, which for most people means the rest of their life.

Your Initial Enrollment Period is a seven-month window — the three months before your 65th birthday month, your birthday month, and the three months after.

What the Part D late-enrollment penalty looks like

Part D covers prescription drugs. If you go 63 days or more in a row without "creditable" drug coverage after you're first eligible, you can owe a Part D late-enrollment penalty when you finally sign up.

The penalty is calculated as 1% of the "national base beneficiary premium" for each full month you went without creditable coverage. It's added to your Part D premium every month, generally for as long as you have Part D.

"Creditable" coverage is drug coverage — from an employer, union, VA, or another source — that Medicare considers at least as good as standard Part D. Your plan is required to send you a notice each year telling you whether your coverage is creditable. Save those letters.

Why Rochester is a little different

Rochester is in Olmsted County, and it's a city where a lot of residents keep working past 65 — often at Mayo Clinic or connected employers — with strong group health coverage. That's usually good news for late-enrollment penalties, but only if you handle the transition carefully.

A few local realities worth knowing:

• If you have employer coverage from a company with 20 or more employees, you generally can delay Part B without a penalty and use a Special Enrollment Period when you retire.
• If the employer has fewer than 20 employees, Medicare usually needs to be primary at 65, and delaying Part B could create a penalty later.
• Retiree coverage and COBRA are not the same as active employer coverage for penalty purposes. This trips up a lot of people.

When in doubt, ask your HR department in writing whether your coverage counts as creditable, and keep the answer.

How to avoid the penalties

The good news: these penalties are rule-based, so a little planning goes a long way.

1. Mark your Initial Enrollment Period. It starts three months before your 65th birthday month. Set a calendar reminder now. 2. Confirm whether your current coverage is creditable. Ask your employer, union, or plan in writing. Keep the notice. 3. Enroll in Part D on time, even if you don't take many prescriptions. A low-cost plan is usually cheaper over a lifetime than a growing penalty. 4. Use your Special Enrollment Period if you're leaving employer coverage. You generally have 8 months to sign up for Part B without a penalty. 5. Don't rely on COBRA to protect you from Medicare penalties. It doesn't.

Where to get unbiased help in Rochester

You don't have to sort this out alone, and you don't have to talk to a salesperson to get answers. Minnesota's State Health Insurance Assistance Program (SHIP) — called the Senior LinkAge Line in Minnesota — provides free, one-on-one Medicare counseling. You can reach them at 1-800-333-2433.

You can also:

• Visit medicare.gov to compare coverage and check enrollment dates.
• Call 1-800-MEDICARE (1-800-633-4227), 24/7.
• Contact Social Security at 1-800-772-1213 to enroll in Part A and Part B.

A few 2026 and 2027 numbers worth knowing

While you're planning, it helps to know how the rest of the program is shaping up:

• Part D has a new $2,100 out-of-pocket cap for covered drugs in 2026.
• The maximum Part D deductible is $615.
• The old "donut hole" coverage gap was eliminated in 2025 — Part D now has three phases.
• IRMAA surcharges (higher premiums for higher incomes) begin above $109,000 for a single filer in 2026.
• Annual Enrollment runs Oct. 15 – Dec. 7, and Medicare Advantage Open Enrollment runs Jan. 1 – March 31.