How does the Part B penalty work?
When you first become eligible, you have a seven-month Initial Enrollment Period around your 65th birthday month. If you don't sign up for Part B then, and you don't have group health coverage from your own or your spouse's current job, Medicare counts the months until you do sign up. Each full 12 months adds 10% of the standard premium. A 30-month gap is two full periods, so 20%. In 2026 that is 20% of $202.90, about $40.58 a month on top of your premium.
The penalty follows the standard premium, so it rises when the premium does, and you generally pay it for as long as you have Part B. Coverage that doesn't protect you from the Part B penalty includes retiree coverage, COBRA, Marketplace plans and VA health care.
Ohio public retirees: OPERS, STRS Ohio, SERS and OP&F all tell Medicare-age retirees to enroll in Part B, and STRS Ohio and SERS end retiree medical coverage if you decline or drop it. Retiree coverage from your system is not coverage from current work, so a gap in Part B can cost you both your retiree coverage and a lifelong penalty. See Ohio public retirement systems and Medicare.
If you're still working for a school district, a city or the state at 65 and have group coverage through that job, you can usually wait without a penalty; see working past 65. Veterans and TRICARE users should read veterans, TRICARE and military retirees in Ohio.
How does the Part D penalty work?
The Part D penalty applies if, after your Initial Enrollment Period, you go 63 days or more in a row without a Medicare drug plan or other creditable drug coverage. Creditable coverage is drug coverage expected to pay at least as much as standard Part D; your employer, union or other plan sends a notice each year saying whether yours is. Keep those notices: they are your proof if Medicare later asks. VA drug coverage counts as creditable.
The penalty is 1% of the national base beneficiary premium for each full month without coverage. In 2026 the base premium is $38.99, so a 24-month gap adds 24% of it to your monthly drug plan premium: $9.36 before Medicare rounds it to the nearest 10 cents. The base premium changes every year, so the penalty does too. More on drug plans is on Medicare Part D in Ohio.
The group Medicare plans STRS Ohio and SERS offer include Part D drug coverage. If you buy coverage through the OPERS Medicare Connector or OP&F's marketplace, choose a plan that includes drug coverage or add a separate Part D plan, unless you have other creditable drug coverage.
How can Ohioans get the penalties removed?
Medicare says that if you enroll in a Medicare Savings Program you won't pay a Part B late penalty, and if you qualify for Extra Help you don't pay a Part D late penalty.
- Ohio Medicare Premium Assistance Programs. Ohio Medicaid pays your Part B premium, and with QMB also your Medicare deductibles and coinsurance. Ohio checks income and resources; in 2026 countable resources must be no more than $9,950 for one person or $14,910 for a couple, and your home and one car don't count. Apply at benefits.ohio.gov or your county Job and Family Services office, and check your numbers with the savings programs screener. Read Medicare Savings Programs in Ohio.
- Extra Help. If you are in a premium assistance program, have full Ohio Medicaid or get Supplemental Security Income, you get Extra Help automatically. Otherwise you can apply with Social Security. Its resource limit is higher than the premium assistance programs' limit. See Extra Help in Ohio.
- Special Enrollment Periods. If you had group coverage from current work, you generally have eight months after that job or coverage ends to sign up for Part B without a penalty. See enrollment periods for this and other situations.
Sources
- Medicare.gov — Avoid late enrollment penalties
- Medicare.gov — Part D costs and the late enrollment penalty
- Medicare.gov — Creditable prescription drug coverage
- eCFR — 42 CFR 423.286, Rules regarding premiums (late enrollment penalty)
- CMS — 2026 Medicare Parts A & B premiums and deductibles
- Ohio Administrative Code 5160:1-3-02.1 — Medicare premium assistance programs
- STRS Ohio — Medicare enrollment (Part B required)
- SERS — 2027 Member Health Care Guide (Part B requirement) (PDF)
- OPERS — 2026 Health Care Program Guide (Medicare Parts A and B) (PDF)
- OP&F — Retiree health care (Medicare Parts A and B)
Frequently asked questions
How is the Part D late enrollment penalty calculated?
Medicare multiplies 1% of the national base beneficiary premium ($38.99 in 2026) by the number of full months you went without Part D or other creditable drug coverage, and rounds to the nearest 10 cents. It is added to your drug plan premium, and the amount changes each year with the base premium.
How much is the Part B late penalty in 2026?
10% of the standard Part B premium for each full 12-month period you could have had Part B but didn't, with no group coverage from current work. In 2026 each 10% is about $20.29 a month, and you generally pay it for as long as you have Part B.
Can Ohio Medicaid make my Part B penalty go away?
Yes. Medicare says you won't pay a Part B late penalty if you enroll in a Medicare Savings Program. In Ohio those are the Medicare Premium Assistance Programs (QMB, SLMB and QI-1), and your county Job and Family Services office decides eligibility. Ohio counts both income and resources, so check both with the savings programs screener.
Does my OPERS, STRS Ohio or SERS retiree coverage protect me from the Part B penalty?
No. Retiree coverage isn't group coverage from current work, so it doesn't give you a Special Enrollment Period for Part B. Ohio's retirement systems also require Medicare-age retirees in their health care programs to enroll in Part B, so sign up when you're first eligible.
What if I think my penalty is wrong?
For Part D, you can ask for a reconsideration; your plan's penalty letter explains how and gives a deadline. For Part B, contact Social Security, especially if you had group coverage from your own or your spouse's current work during the months counted.
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