Medicare Supplement

Miss These Medicare Deadlines and Pay for Life

Most Medicare mistakes are fixable. A late-enrollment penalty usually is not. For many people in Allentown turning 65 this year, the biggest risk isn't picking the "wrong" plan — it's missing a deadline they didn't know applied to them.

ALLENTOWN, Pa. — A missed Medicare sign-up can follow you for decades

The penalties for signing up late for Part B (doctor visits) and Part D (prescription drugs) are added to your monthly premium, and in most cases they stick with you for as long as you have Medicare. Here's how they work, and how to steer clear of them.

Your first deadline: the Initial Enrollment Period

When you first become eligible for Medicare, you get a seven-month window called your Initial Enrollment Period. It starts three months before the month you turn 65, includes your birthday month, and runs three months after.

If you're already getting Social Security when you turn 65, you'll usually be enrolled in Parts A and B automatically. If you're not, you have to sign up yourself through the Social Security Administration. This is where a lot of people get tripped up — especially those still working past 65.

The Part B late penalty: 10% for each year you delay

If you don't sign up for Part B when you're first eligible — and you don't qualify for a Special Enrollment Period — the penalty is 10% added to your monthly Part B premium for every full 12 months you could have had it but didn't.

That penalty is permanent. If you delayed Part B for three years, you'd pay an extra 30% every month, for life.

The most common way to avoid it: if you or your spouse are still working and you have health coverage through that job, you may qualify for a Special Enrollment Period to sign up for Part B later without a penalty. COBRA and retiree coverage do not count as "current employer coverage" for this rule. That surprises a lot of people.

The Part D late penalty: small numbers that add up

Part D has its own penalty, and it works differently. If you go 63 days or more without "creditable" prescription drug coverage after you were first eligible, you can owe a Part D late-enrollment penalty when you finally sign up.

The penalty is 1% of the "national base beneficiary premium" for each full month you went without coverage, added to your Part D premium. Like the Part B penalty, it generally lasts as long as you have Part D.

"Creditable" simply means the drug coverage you had was expected to pay, on average, at least as much as standard Medicare drug coverage. If you have drug coverage through an employer, union, or the VA, ask them in writing whether it's creditable — and keep the letter. You may need it later.

What's changing for 2026

Even if you're already enrolled, it helps to know what the drug benefit looks like now:

• The Part D out-of-pocket cap is $2,100 in 2026. Once your out-of-pocket spending on covered drugs hits that amount, you pay $0 for covered drugs the rest of the year.
• The Part D maximum deductible is $615.
• The old "donut hole" coverage gap was eliminated as of 2025. Part D now has three phases instead of four.
• The Medicare Prescription Payment Plan lets you spread your out-of-pocket drug costs across the calendar year in monthly installments instead of paying big amounts at the pharmacy counter. It's optional and free to join.
• IRMAA — the income-related surcharge on Part B and Part D premiums — kicks in above $109,000 in income for a single filer in 2026 (higher for joint filers).

The Allentown picture

Allentown sits in Lehigh County, and Medicare plan availability — Medicare Advantage plans and stand-alone Part D drug plans — is set at the county level by the Centers for Medicare & Medicaid Services. That means two neighbors on the same street have the same menu of plans to choose from, but someone across the county line in Northampton or Berks may see a different list.

If you want the current count of plans and carriers available in Lehigh County for 2026, the Plan Finder tool at Medicare.gov will show it when you enter your ZIP code. Pennsylvania's APPRISE program — the state's SHIP (State Health Insurance Assistance Program) — offers free, unbiased counseling in Lehigh County and can walk you through your options in person or by phone.

Key dates to circle

• Initial Enrollment Period: the 7-month window around your 65th birthday.
• Annual Enrollment Period: October 15 – December 7 each year, when anyone with Medicare can change Part D or Medicare Advantage coverage for the following year.
• Medicare Advantage Open Enrollment Period: January 1 – March 31, when people already in a Medicare Advantage plan can switch to a different one or return to Original Medicare.
• General Enrollment Period: January 1 – March 31, for people who missed their initial Part B window and don't qualify for a Special Enrollment Period.