Medicare 2026

How Waco enrollees trigger Medicare Part B and D penalties

WACO, Texas — Miss a Medicare sign-up window, and the bill can follow you for the rest of your life. That's the hard truth behind two of the program's least-understood rules: the late-enrollment penalties for Part B and Part D.

The good news? These penalties are almost entirely avoidable once you know when the clock starts — and when it stops.

Why Medicare has late penalties at all

Medicare works a bit like insurance pools everywhere: it needs people to sign up on time so costs stay balanced. To encourage that, the Centers for Medicare & Medicaid Services (CMS) adds a permanent surcharge to your monthly premium if you delay Part B (doctor visits, outpatient care) or Part D (prescription drugs) without a good reason.

"Permanent" is the word that trips people up. These are not one-time fees. In most cases, they stick to your premium for as long as you have Medicare.

The Part B penalty: 10% for every 12 months you wait

If you don't sign up for Part B when you're first eligible — and you don't have other qualifying coverage, like a current employer's plan — your monthly Part B premium can go up 10% for each full 12-month period you could have had it but didn't.

A few key points to keep in mind:

• Your Initial Enrollment Period is a 7-month window around your 65th birthday: the 3 months before, your birthday month, and the 3 months after.
• If you're still working at 65 and have health coverage through your job (or your spouse's job), you usually get an 8-month Special Enrollment Period after that coverage ends to sign up without a penalty.
• COBRA and retiree coverage do not count as active employer coverage for this purpose. This is one of the most common — and most expensive — mistakes.

If you miss your window and don't qualify for a Special Enrollment Period, you'll generally have to wait for the General Enrollment Period (January 1 – March 31) to sign up, with coverage starting the month after you enroll.

The Part D penalty: small numbers that add up

The Part D penalty looks smaller on paper, but it works the same way — forever.

CMS calculates it as 1% of the "national base beneficiary premium" for every full month you went without Part D or other creditable drug coverage after becoming eligible. That amount is then added to your monthly Part D premium each year.

"Creditable" is the important word. It means drug coverage that CMS considers at least as good as basic Medicare Part D. Employer plans, union plans, and VA benefits often qualify — but you should get that in writing from the plan each year. Keep those notices.

You generally trigger the Part D penalty if you go 63 days or more without creditable drug coverage after your Initial Enrollment Period ends.

What's new for 2027 — and why signing up on time matters more

Part D looks different than it did just a couple of years ago, which changes the math on whether it's worth enrolling.

• The Part D out-of-pocket cap on covered prescription drugs is $2,100 in 2026 and $2,400 in 2027. Once you hit it, you pay nothing more for the rest of the year on covered medications.
• The maximum Part D deductible is $615 for 2026 and $700 for 2027.
• The old "donut hole" is gone as of 2025 — Part D now has three simpler phases.
• The Medicare Prescription Payment Plan lets you spread your drug costs across the year in monthly payments instead of paying a big bill at the pharmacy counter.
• IRMAA surcharges — higher premiums for higher earners — start above $109,000 in income for a single filer in 2026.

For many people who once skipped Part D because they "didn't take many drugs," these changes make enrolling on time a safer bet. And avoiding a lifetime penalty is part of that math.

What Waco readers should know locally

Waco is in McLennan County, where a broad mix of stand-alone Part D plans and Medicare Advantage plans with drug coverage is available. The number of plans matters less than picking one that covers your specific prescriptions and pharmacies — and enrolling on time so no penalty ever attaches to your premium.

Two dates to circle:

• October 15 – December 7: Medicare's Annual Enrollment Period, when anyone with Medicare can join, switch, or drop a Part D or Medicare Advantage plan.
• January 1 – March 31: Medicare Advantage Open Enrollment, for people already in a Medicare Advantage plan who want to switch once.

Neither of these windows erases a Part B or Part D late penalty already in place — but they're your chance to get and stay covered going forward.