Medicare 2026

The Medicare Deadlines That Can Cost You for Life

UPPER ARLINGTON, Ohio — Some Medicare mistakes are easy to fix. Missing an enrollment deadline usually isn't one of them. If you sign up late for Part B (doctor visits) or Part D (prescription drugs) without a good reason, you can face a penalty that gets added to your monthly premium — and in most cases, it stays there for as long as you have Medicare.

Here's what Upper Arlington residents need to know about those deadlines, how the penalties are calculated, and the situations that let you skip them entirely.

Why these two penalties matter more than most

Medicare has a lot of moving parts, but the Part B and Part D late-enrollment penalties stand out for one reason: they're usually permanent. That means a short delay in your 60s can quietly raise your Medicare costs into your 80s and 90s.

The good news is that these penalties are avoidable. Most people who get hit with one simply didn't know the rules — or assumed their current insurance counted as Medicare coverage when it didn't.

The Part B late-enrollment penalty

Part B covers doctor visits, outpatient care, and many preventive services. Most people become eligible during their Initial Enrollment Period — a seven-month window that starts three months before the month you turn 65 and ends three months after.

If you don't sign up during that window, and you don't qualify for a Special Enrollment Period, the penalty works like this:

• Your Part B premium goes up 10% for each full 12-month period you could have had Part B but didn't.
• That higher premium generally lasts for as long as you have Part B.

So a two-year delay means a 20% premium increase — for life. A four-year delay means 40%. The penalty is added to the standard Part B premium each year, so as the base premium rises, your penalty amount rises with it.

The Part D late-enrollment penalty

Part D covers prescription drugs. The penalty here works a little differently but follows the same idea: if you go 63 days or more in a row without Part D or other "creditable" drug coverage after you first become eligible, you can owe a penalty when you eventually enroll.

The math:

• Medicare multiplies 1% of the "national base beneficiary premium" by the number of full months you went without coverage.
• That amount is rounded to the nearest 10 cents and added to your Part D premium each month.
• Like the Part B penalty, it generally sticks with you for as long as you have Part D.

The word to remember is creditable. If you have drug coverage through an employer, a union, the VA, or TRICARE, ask the plan in writing whether it counts as creditable coverage under Medicare rules. Insurers are required to tell you.

Who can delay without a penalty

Not everyone has to sign up at 65. You can generally delay Part B — and skip the penalty — if you or your spouse are still working and covered by that employer's group health plan (and the employer has 20 or more employees). When that job-based coverage ends, you get an 8-month Special Enrollment Period to sign up for Part B.

A few important cautions for Upper Arlington readers:

• COBRA and retiree coverage do not count as active employer coverage for this purpose. If you're on COBRA at 65, the clock is still ticking.
• Marketplace (ACA) plans do not count either.
• If you have HSA contributions, enrolling in any part of Medicare will stop them — plan the timing carefully with your employer's benefits office.

Key dates to circle in 2026 and 2027 and 2027

Even if you're already enrolled, some deadlines still matter:

• Initial Enrollment Period: the seven months around your 65th birthday.
• General Enrollment Period: January 1 – March 31, for people who missed their initial window and don't qualify for a Special Enrollment Period.
• Medicare Annual Enrollment Period: October 15 – December 7, when you can change your Part D or Medicare Advantage coverage for the following year.
• Medicare Advantage Open Enrollment Period: January 1 – March 31, for people already in a Medicare Advantage plan who want to switch once.

Upper Arlington is in Franklin County, where a wide range of stand-alone Part D and Medicare Advantage plans are offered each year. Availability and plan details are set at the county level, so two neighbors on either side of a county line may not see the same options.

A few Part D numbers worth knowing

Even outside the penalty rules, a few program-wide figures shape what you'll pay:

• Part D now has a $2,100 annual out-of-pocket cap on covered drugs.
• The Part D deductible is capped at $615.
• The old "donut hole" coverage gap is gone — Part D now has three phases instead of four.
• The Medicare Prescription Payment Plan lets you spread your drug costs across the year in monthly payments, at no extra charge.
• IRMAA — the income-related surcharge on Part B and Part D — begins above $109,000 for a single filer in 2026.