Medicare 2026

Miss a Medicare Sign-Up Window? The Fee Follows You for Life

APEX, N.C. — Turning 65 comes with a stack of decisions, and two of them carry a price tag that can stick with you for the rest of your life. If you delay signing up for Medicare Part B or Part D without the right coverage in place, you can be charged a late-enrollment penalty every month you have Medicare — not just once.

The good news: these penalties are avoidable if you know the rules. Here's how they work, and how Apex residents can steer clear of them.

How the Part B late penalty works

Part B covers doctor visits, outpatient care, and many preventive services. Most people first become eligible for Medicare during a seven-month window around their 65th birthday, called the Initial Enrollment Period.

If you don't sign up for Part B when you're first eligible — and you don't have other qualifying coverage — your monthly Part B premium can go up 10% for each full 12-month period you could have had it. That higher premium generally sticks with you for as long as you have Part B.

Example: Someone who waits three full years to sign up could pay 30% more each month, every month, going forward.

How the Part D late penalty works

Part D covers prescription drugs. The penalty here is calculated differently. Medicare takes 1% of the "national base beneficiary premium" and multiplies it by the number of full months you went without Part D or other creditable drug coverage after becoming eligible.

That amount is rounded to the nearest 10 cents and added to your Part D premium each month, for as long as you have Part D. Because the national base premium can change year to year, the penalty can shift slightly too.

The Part D out-of-pocket cap is $2,100 in 2026 and $2,400 in 2027, and the maximum Part D deductible is $615 in 2026 and $700 in 2027 — figures worth knowing when you compare drug coverage.

What "creditable coverage" means

The word "creditable" is the key to avoiding a Part D penalty. Creditable drug coverage is coverage Medicare considers at least as good as standard Part D — often from an employer, union, or retiree plan, or from TRICARE or the VA.

If you keep creditable coverage after age 65 and enroll in Part D within about two months of losing it, you won't owe a late penalty. Plans are required to send you a notice each year telling you whether your drug coverage is creditable. Save those letters — they are your proof.

For Part B, if you (or your spouse) are still working and covered by a large employer's group health plan, you may be able to delay Part B without a penalty and use a Special Enrollment Period later.

How Apex residents can avoid the penalties

Apex is in Wake County, where Medicare beneficiaries have a range of stand-alone Part D plans and Medicare Advantage plans that include drug coverage to choose from during enrollment periods. The specific choices change each year, which is why the fall Annual Enrollment Period (Oct. 15 – Dec. 7) exists.

To keep penalties off your bill:

• Mark your Initial Enrollment Period — the three months before your 65th birthday month, the month itself, and the three months after.
• If you're delaying Medicare because you're still working, confirm in writing that your current coverage is creditable.
• If you lose employer coverage, act within the Special Enrollment Period, usually eight months for Part B and about two months for Part D.
• Don't skip Part D just because you don't take prescriptions today. Even a low-cost drug plan can shield you from a lifelong penalty later.

Where to get help you can trust

For personalized answers, call 1-800-MEDICARE (1-800-633-4227) or visit medicare.gov. North Carolina residents can also contact the state's SHIIP program (Seniors' Health Insurance Information Program), the local branch of the federal SHIP network, for free one-on-one counseling from trained volunteers.