Medicare 2026

Medicare Late Penalties: What Bismarck Retirees Should Know

BISMARCK, N.D. — Missing a Medicare deadline can cost you every month for the rest of your life. That is the hard truth behind Medicare's late-enrollment penalties for Part B (medical insurance) and Part D (prescription drug coverage). The good news: if you understand how the rules work, you can almost always avoid them.

Why these penalties exist

Medicare is designed to work when a large group of people participate. To keep the program stable, the Centers for Medicare & Medicaid Services (CMS) charges late fees to people who wait to sign up without a good reason. The penalties are not a one-time fine — they are added to your monthly premium, often permanently.

That is why understanding the timing matters as much as understanding the coverage.

How the Part B penalty works

Most people first become eligible for Medicare during their Initial Enrollment Period — a 7-month window that starts three months before the month you turn 65 and ends three months after.

If you don't sign up for Part B during that window, and you don't have other coverage that counts, your monthly Part B premium can go up 10% for each full 12-month period you delayed. In most cases, you'll pay that higher amount for as long as you have Part B.

There is also a limited General Enrollment Period each year (January 1 – March 31) for people who missed their first chance.

How the Part D penalty works

The Part D penalty works a little differently. If you go 63 days or more in a row without "creditable" prescription drug coverage after you're first eligible, you may owe a penalty when you finally join a Part D plan.

The amount is calculated as 1% of the "national base beneficiary premium" times the number of months you went without coverage, rounded to the nearest 10 cents. That fee is added to your monthly Part D premium — again, usually for as long as you're enrolled.

"Creditable" simply means the drug coverage you had was expected to pay, on average, at least as much as a standard Medicare drug plan. Employer plans, union plans, and VA benefits often qualify, but you should get that in writing from the plan.

Who is protected from the penalty

You generally will not face a late penalty if you:

• Are still working at 65 and covered by a qualifying employer group health plan (or covered through a working spouse).
• Have TRICARE, VA drug benefits, or another form of creditable coverage.
• Qualify for a Special Enrollment Period after losing that coverage — usually 8 months for Part B and 63 days for Part D.

Keep every notice your employer or plan sends about whether your coverage is "creditable." That paperwork is what protects you later.

What Bismarck residents should know locally

Bismarck is in Burleigh County, where Medicare beneficiaries can choose between Original Medicare (Parts A and B, often paired with a standalone Part D drug plan) and Medicare Advantage plans offered by private insurers. The rules on late-enrollment penalties apply the same way statewide — but the plan choices, pharmacy networks, and available help vary by county.

North Dakota's State Health Insurance Counseling program, known as SHIC, offers free one-on-one help to people in Bismarck and across the state. Counselors don't sell plans; they help you understand your options and your deadlines.

Key 2027 dates and figures to remember

• Annual Enrollment Period: October 15 – December 7 (changes take effect January 1).
• Medicare Advantage Open Enrollment: January 1 – March 31.
• General Enrollment Period for Part B: January 1 – March 31.
• Part D maximum deductible: $615 in 2026 and $700 in 2027.
• Part D out-of-pocket cap: $2,100 in 2026 and $2,400 in 2027. Once you reach that amount, you pay nothing more for covered drugs the rest of the year.
• Medicare Prescription Payment Plan: an optional program that lets you spread drug costs across the year in monthly installments.
• IRMAA (higher premiums for higher incomes): kicks in above $109,000 for a single filer in 2026.

The old "donut hole" coverage gap was eliminated in 2025, so Part D now has three phases: deductible, initial coverage, and catastrophic.