The Medicare Part B late enrollment penalty is 10% of the standard premium for every full 12 months you delayed without qualifying employer coverage. With the 2026 standard Part B premium at $202.90/mo, a 3-year delay means a permanent 30% surcharge — $60.87/mo extra for the rest of your life. This penalty never expires and increases as premiums rise. The Part D late enrollment penalty is calculated separately: 1% of the $37.20 national base premium per uncovered month, also permanent and uncapped. For your specific situation in Durham County, call Rob Simm at (828) 761-3326 — free, no obligation.

What Durham families ask

What scares people most about the Part B penalty?

These are the four questions I hear most from Durham County residents who delayed enrollment.

Is the penalty really permanent?

Yes. The Part B late enrollment penalty lasts for the rest of your life. It is recalculated each year against the current premium, so the dollar amount grows as premiums increase.

Can I appeal or get a waiver?

Only if you had qualifying employer coverage (employer with 20+ employees) and can prove it with a Certification of Creditable Coverage. There is no hardship waiver, income-based exception, or one-time forgiveness.

Does Part D have a penalty too?

Yes. The Part D penalty is 1% of the $37.20 national base premium per uncovered month. 36 months uncovered = $13.39/mo added permanently. This stacks on top of your Part B penalty.

What if my employer had fewer than 20 people?

If your employer has fewer than 20 employees, Medicare is primary. Your employer plan was secondary the entire time — meaning you should have enrolled in Part B at 65. The penalty still applies.

⚠️ The penalty is permanent and has no cap

A 3-year delay costs $60.87/mo extra in 2026 — over $14,600 across a 20-year retirement. A 5-year delay costs $101.45/mo extra — over $24,300. And every year the standard premium rises, your penalty dollar amount rises with it. There is no cap, no expiration, and no forgiveness program. The only protection is enrolling on time or documenting qualifying employer coverage before you retire.

The difference

What happens when you figure this out alone vs. with an NC broker?

What do you need to know?	Medicare.gov	Rob Simm — NC #10447418
Penalty calculation	Generic formula, no personalized math	Exact dollar amount based on your delay length and 2026 premium
Creditable coverage check	Lists the rules — doesn't verify your employer	I call your HR, confirm employer size, and get your coverage letter
SEP eligibility after employer coverage	Says you have 8 months — no deadline coaching	I map your exact SEP window and handle the CMS-L564 form
Part D penalty stacking	Mentions it exists — no combined cost projection	I calculate Part B + Part D penalty combined so you see total lifetime cost
Next-year premium impact	Only shows current year	I project how rising premiums increase your penalty dollar amount over time
Cost	$0 (plus your time and risk)	$0 — paid by carrier, same commission regardless of plan

2026 Medicare numbers

What are the key 2026 Medicare figures for penalty calculations?

$202.90

Part B premium per month

2026 standard rate. Higher with IRMAA surcharge based on income above $106,000.

$283

Part B annual deductible

You pay this before Medicare covers 80% of outpatient care.

$9,350

MA in-network out-of-pocket max

2026 cap on in-network Medicare Advantage spending.

$2,100

Part D out-of-pocket cap

No catastrophic Rx costs in 2026. Insulin capped at $35/month.

💡 Broker Tip — Durham County

The most common penalty situation I see in Durham County: someone working at a small employer (under 20 employees) past 65 who assumed their group plan was “creditable.” It wasn’t — because Medicare was primary the whole time. Before you retire from any employer, ask HR for a written Certification of Creditable Coverage and confirm your employer size. If you’re not sure, call me at (828) 761-3326 — I’ll verify it for you in 10 minutes.

— Rob Simm, Licensed Medicare Broker, NC #10447418

10 minutes. You'll know where you stand.

Rob Simm · Licensed NC Medicare Broker · NPN #10447418

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Real scenario · Durham County

What does a 1-year delay cost vs. a 3-year delay?

Delayed 1 Year

+$20.29/mo

10% surcharge on $202.90 = $223.19/mo Part B premium. That's $4,870 extra over a 20-year retirement. Permanent — recalculated upward every year as the base premium rises.

Delayed 3 Years

+$60.87/mo

30% surcharge on $202.90 = $263.77/mo Part B premium. That's $14,610 extra over 20 years. Add the Part D penalty ($13.39/mo for 36 uncovered months) and you're looking at $74.26/mo in combined penalties — for life.

It pays to talk to the right broker

Does it cost me anything to get penalty advice from a broker?

It doesn’t — because I get paid by the insurance carrier to manage your plan. Most call centers get paid more to steer your business toward certain carriers based on volume and contracts. The only thing I’m optimizing for is making sure you’re covered correctly when you actually need it. That’s what keeps people coming back. And referring their neighbors.

Common questions

Frequently asked questions

Can I ever get rid of the Part B late enrollment penalty?

No. The Part B late enrollment penalty is permanent. It is recalculated every year based on the current standard premium, so as premiums rise, the dollar amount of your penalty rises too. The only exception is if you qualify for Medicare due to disability and later age into Medicare at 65 — the penalty resets at that point.

Does employer coverage protect me from the Part B penalty?

Only if the employer has 20 or more employees and offers group health coverage that is primary to Medicare. If your employer has fewer than 20 employees, Medicare is primary and your employer plan is secondary — meaning you should have enrolled in Part B at 65 or you will face the penalty. Always get a written Certification of Creditable Coverage from HR before retiring.

How is the Part D late enrollment penalty calculated?

The Part D penalty is 1% of the national base beneficiary premium ($37.20 in 2026) multiplied by the number of full months you went without creditable prescription drug coverage. For example, 36 months uncovered = 36% × $37.20 = $13.39/month added to your Part D premium permanently.

What if I had VA or TRICARE coverage — do I still owe a penalty?

VA coverage and TRICARE are considered creditable coverage for both Part B and Part D purposes. If you had continuous coverage through either program, you should not owe a late enrollment penalty. Keep documentation proving your coverage dates.

Is there a fee to talk to a Medicare broker about my penalty situation?

No. Brokers are paid by the insurance carrier when you enroll, and the commission is identical whether you enroll directly, through Medicare.gov, or through a broker. Call Rob Simm at (828) 761-3326 — free, no obligation, no SSN required.

Related Medicare guides

Medicare Enrollment in NC – 2026 Guide Extra Help/LIS Eligibility NC 2026 Compare Medicare Advantage Plans in NC Extra Help / LIS in NC – 2026 Eligibility Guide Working Past 65 – Medicare Enrollment Special Enrollment Periods in NC Cheap Health Insurance Without Employer Coverage Free Medicare Quotes Online

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Robert Simm

Licensed Independent Medicare Broker

Helping NC families navigate Medicare since 2014. Independent — I work with all carriers and get paid the same regardless of which plan you choose. I verify provider networks with Duke Health directly and answer my own phone the next year when something changes.

📞 (828) 761-3326 📋 NC #10447418 🏥 AHIP Certified ⭐ 5.0 · 20+ reviews 📍 2731 Meridian Pkwy, Durham NC 27713 🕐 Mon–Fri 9am–7pm ET

Last Updated: 2026-05-03 | Reviewed By: Robert Simm, Licensed Medicare Broker, NC #10447418 | Next Review: October 2026

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