The Part B late enrollment penalty is 10% of the standard premium for every full 12 months you delayed without qualifying employer coverage. An 18-month delay rounds down to one 12-month period = 10% surcharge = $20.29/mo added to your $202.90 Part B premium — for the rest of your life. A 3-year delay = 30% = $60.87/mo extra forever. The Part D penalty is 1% of $37.20 per uncovered month, also permanent. For your specific situation, call Rob Simm at (828) 761-3326 — free, no obligation.

What NC families ask

What makes the Part B penalty so dangerous?

Four things most people don't realize until it's too late.

It never goes away

The Part B penalty is permanent. It's added to your premium every month for the rest of your life — and it increases as the standard premium increases each year.

Small employers don't protect you

If your employer has fewer than 20 employees, Medicare is primary. Your employer coverage doesn't count as creditable — and every month past 65 adds to your penalty.

You can't enroll whenever you want

If you miss your IEP and don't qualify for a Special Enrollment Period, you can only enroll during General Enrollment (Jan 1–Mar 31) with coverage starting July 1 — and the penalty starts immediately.

Part D has its own separate penalty

1% of $37.20 per month without creditable drug coverage. A 2-year gap = $8.93/mo extra on top of your Part D premium — also for life. The base premium rises annually, so the dollar amount grows.

⚠️ The penalty is permanent and has no cap

There is no maximum on the Part B late enrollment penalty. A 10-year delay = 100% surcharge = $405.80/mo instead of $202.90/mo — for life. And the Part D penalty compounds because the national base premium increases each year. The only protection is qualifying employer coverage from a company with 20+ employees. If you're unsure whether your coverage qualifies, call (828) 761-3326 before your window closes.

The difference

What happens when you navigate the penalty 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 and 2026 rates
Employer coverage verification	Says “check with your employer”	I verify employer size + coverage type and document it
SEP eligibility	Lists rules — doesn't tell you which apply	I identify every SEP you qualify for and file the paperwork
Part D penalty stacking	Mentions it exists	I calculate both penalties together against your actual drug list
Appeal options	Form CMS-20063 — you're on your own	I prepare the appeal package with creditable coverage documentation
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 that affect my penalty?

$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 past 65 at a small employer — a Duke subcontractor, a local practice, a nonprofit — with fewer than 20 employees. They assume their employer plan is creditable. It isn't. Every month past their IEP adds 10% per year to their Part B premium for life. Before you assume you're covered, call me and I'll verify your employer size and plan type in 10 minutes. It's the most important phone call you'll make this year.

— Rob Simm, Licensed Medicare Broker, NC #10447418

10 minutes. You'll know where you stand.

Rob Simm · Licensed NC Medicare Broker · NPN #10447418

Now pick how you want to move forward — your pace.

PLAN MATCH · 3 MINUTES

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Real scenario · Durham County

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

Delayed 3 years

+$60.87/mo

30% surcharge on $202.90 = $263.77/mo Part B premium. That's $14,610 extra over a 20-year retirement — and the penalty rises as the premium rises each year. Permanent. No appeal without creditable coverage proof.

Enrolled on time

$202.90/mo

Standard 2026 Part B premium. No penalty. No surcharge. No permanent mark on your Medicare record. This is the number you want — and the only way to get it is to enroll during your IEP or have qualifying employer coverage.

It pays to talk to the right broker

Why doesn't it cost me anything to work with 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

How is the Part B penalty calculated for an 18-month delay?

Medicare rounds down to full 12-month periods. An 18-month delay counts as one full 12-month period, so the penalty is 10% of the standard Part B premium — $20.29/mo added to your $202.90/mo premium for the rest of your life. A 24-month delay would be 20%.

Does employer coverage from a company with fewer than 20 employees protect me from the penalty?

No. If your employer has fewer than 20 employees, Medicare is your primary payer and your employer plan is secondary. You must enroll in Part B during your IEP or you will face the late enrollment penalty — even though you had employer coverage. This is the most common mistake I see in NC.

Can I appeal or remove a Part B late enrollment penalty?

Only if you can prove you had qualifying creditable coverage — employer group health from a company with 20+ employees, or certain other qualifying plans. You'll need a Certification of Creditable Coverage from your former employer's HR department. Without that documentation, the penalty is permanent. Call (828) 761-3326 and I'll help you determine if you have grounds for an appeal.

Is the Part D late enrollment penalty also permanent?

Yes. The Part D penalty is 1% of the national base beneficiary premium ($37.20 in 2026) multiplied by the number of months you went without creditable prescription drug coverage. This amount is added to your Part D premium for life, and the base premium can increase each year.

What if I delayed Part B because I was working past 65 — do I still owe a penalty?

It depends on your employer size. If you worked for a company with 20+ employees and had employer group health coverage, you're protected — you get an 8-month Special Enrollment Period after you leave that job or lose that coverage. If the employer had fewer than 20 employees, Medicare was primary and your delay counts toward the penalty. Call (828) 761-3326 to verify your specific situation.

Related Medicare guides

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

Get help in nearby NC counties

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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: 2026-05-04 | Reviewed By: Robert Simm, Licensed Medicare Broker, NC #10447418 | Next Review: October 2026

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