No medications? Why skipping Part D can cost you for life

And that's kind of the whole point Ian's making. He opens with this caller, someone who described their situation almost exactly the way thousands of healthy retirees would: I don't take any statins regularly or anything like that, so I don't have anything that I take. And the implied question is, why on earth would I pay for a drug plan I'm not going to use? It's actually a very reasonable question. And Ian says there are two reasons to enroll anyway, and neither one of them is about the pills you're taking today.

The first one is the penalty, and this is where it gets very concrete. Medicare keeps score. If you go 63 days or more without drug coverage that counts as creditable, from the end of your Initial Enrollment Period onward, they apply a late enrollment penalty to your premium when you eventually do join. And that penalty is not temporary. It stays with you for as long as you have Medicare drug coverage, even if you switch plans.

Not even close. It follows you. And Ian actually shows the math in the piece, which I appreciate because it's the kind of thing that's hard to feel until you see the numbers laid out. The formula uses something called the national base beneficiary premium, which for 2026 is $38.99. You take one percent of that number and you multiply it by the number of full months you went without coverage. So if you skipped coverage for a year, twelve months, you're looking at about $4.70 a month added to your premium. Forever.

That's the thing. Ian walks through a whole progression. Twenty-four months without coverage, that's $9.40 a month. Thirty months, you're at $11.70, which is roughly $140 a year. Sixty months, $23.40 a month, about $281 a year. And then he gives you the scenario that I think is the real gut-check: someone who's 65 and healthy, skips Part D entirely, and then needs it at 75. That's 120 months. The penalty alone is $46.80 a month, about $560 a year, on top of whatever the plan costs. And it never goes away.

And Ian includes this story from a real phone call that really illustrates how this plays out. A man who had a deduction coming out of his Social Security check that he couldn't explain. He called and said, it says it's for late enrollment penalty, but what is a late enrollment penalty? Why? And Ian's point is that by the time someone is asking that question, the answer is usually years ago, and there is nothing to be done about it.

And it compounds, which is the part that makes it worse. Because the base premium, that $38.99 number, gets reset every year. So the penalty is recalculated against the new base every single year. If the base goes up, the penalty goes up with it. It does not fade. Ian's phrasing is that it follows the base premium up, and that's exactly what happens.

Right, and this one operates differently from the penalty. It's not about cost, it's about access. The idea is that you cannot simply sign up for Part D whenever you want to. There are specific windows, your Initial Enrollment Period, the Annual Enrollment Period which runs October 15 to December 7 each year with coverage starting January 1, and Special Enrollment Periods for specific life events. Ian lists things like moving or losing other coverage as examples of what qualifies.

A new diagnosis. That's the scenario Ian uses, and it's the one that matters. Say you skip the plan, you're healthy, you're fine, and then in February a doctor hands you a prescription that costs real money. You cannot enroll at that moment. So you pay full retail from February all the way through until the next January when coverage can actually start. And then the penalty begins on top of that.

That's it. And Ian puts it in a line that I thought was pretty sharp. Not taking medication is a fact about today. It is not a plan. Because good health right now tells you nothing reliable about what a prescription will cost you in February.

And this is the part of Ian's piece that really does make the math feel clean. He pulls specific numbers from Arizona and Nevada. In both states, for 2026, there are ten stand-alone drug plans, and in both states the lowest monthly premium is zero dollars. Nothing.

You can. Now, that doesn't mean every plan is zero, and Ian is careful to flag that a zero-dollar plan this year is not automatically zero next year. Plans change their premiums and their drug lists every year, which is why reviewing it every fall matters. But the point he's making is that the floor is zero. And then on top of that, every Part D plan in 2026 caps what you pay out of pocket for covered drugs at $2,100 for the year.

That's the whole picture right there. So the comparison Ian's laying out is: a zero or low-premium plan that you may never use, which starts the penalty clock at nothing and gives you a $2,100 cap the day a diagnosis shows up. Or no plan, a penalty that grows every month you wait, and a year of retail prices before you can even fix the situation. He says, and I think this is fair, that he's done harder math than that.

Ian addresses this directly, and the answer is no. A pharmacy discount card saves you money at the counter, and that's real, but it does not count as creditable coverage. So it does nothing to stop the penalty clock from running. You can save twenty dollars on a prescription today and still rack up years of late enrollment penalty. They are two completely separate things.

Ian mentions a few. A current or former employer's plan. TRICARE. And the VA. So if you're a veteran who has VA drug coverage and you keep it active, that counts. Ian actually says yesterday's veteran can breathe easy as long as he keeps that VA coverage going. But the key word there is keeps. You'd want to make sure you have documentation of that coverage, because the paperwork matters if you ever need to prove it.

And Ian specifically pushes back on that instinct with a phrase he coins: the cheapest sticker. The work a Certified Medicare Planner does isn't just finding the lowest premium, it's matching the plan to the pharmacy you actually use. Because the same plan can have very different costs depending on which network pharmacy you go to, and if your pharmacy isn't in network, that low premium suddenly doesn't look so good. Wait — I need to actually fix the opening. Let me rewrite: That phrase he coins is worth sitting with: the cheapest sticker. The work a Certified Medicare Planner does isn't just finding the lowest premium, it's matching the plan to the pharmacy you actually use. Because the same plan can have very different costs depending on which network pharmacy you go to, and if your pharmacy isn't in network, that low premium suddenly doesn't look so good.

Most people don't. And then there's the annual review piece. Ian lists that as a specific part of what these planners do, reviewing it every fall, because the plan landscape changes every October. A plan that was zero this year might not be zero next year. The drug formulary, which is the list of drugs the plan covers and at what tier, can change too. So what worked well for you this year might need to be revisited.

Not if you want to stay in the right plan. And Ian also mentions the documentation side, which I think gets underestimated. Keeping the paperwork that proves creditable coverage from a job or the VA so a penalty is never charged by mistake. Because mistakes do happen, and if one does, knowing how to appeal it is a different skill set than most people have on their own.

Ian says yes, and that a Certified Medicare Planner knows how to do that. The specifics of how that appeal process works, the exact steps and timelines, that's really a question for one of our advisors at American Retirement Advisors. But the fact that it's possible, and that having someone in your corner who knows the process matters, that comes through clearly in the piece.

That's the whole point. You have done the planning, you have the coverage, and when the moment comes, you're not scrambling. You're not calling around trying to figure out what retail costs. You already know the answer, and the answer is manageable.

The Annual Enrollment Period runs October 15 through December 7. Coverage that you enroll in during that window starts January 1. So if you're sitting there right now without a drug plan, that is your next door in, and it closes December 7. Ian says exactly that in the piece.

Friday, October 2nd. Two locations. Foothills Library in Glendale at 10:30 in the morning, and Mustang Library in Scottsdale at 2:30 in the afternoon. No cost to attend. You can register at 123easymedicare.com or call 877-220-1089. And if you want to reach the advisors directly, the number in the article is 602-281-3898.

It's completely rational. The problem is it's applied to the wrong time horizon. You're making a decision based on February of this year, but the penalty lives with you for the rest of your life. The math doesn't care how healthy you feel today.

Which is why Ian wrote the piece. He's an engineer, he says so right at the top, and he laid out every step of the math so it's not abstract. One percent of $38.99, times the number of months, and you can see exactly what waiting costs. There's no ambiguity in it.

That's a great question and the honest answer is, it depends on whether that employer plan counts as creditable coverage. Ian mentions employer plans as something that does count, but the specifics of any particular plan and whether it meets Medicare's definition of creditable, that's something I'd really want someone to verify with one of our advisors rather than assume. Because assuming is exactly how people end up with a penalty they didn't expect.

Because the stakes are permanent. This is not a situation where you can fix it next year if you got it wrong. The penalty sticks.

First, understand your enrollment window. Know when your Initial Enrollment Period is, because that's your first opportunity and you don't want to miss it. If you already have creditable coverage through an employer or the VA, keep the documentation. Don't just assume you'll be able to prove it later. If you don't have creditable coverage, look at the plans available in your state. Ian's numbers show that in Arizona and Nevada, there are zero-premium options, so the barrier to entry is very low.

That's the whole point of the Annual Enrollment Period. Because what's right for you this October might not be right next October. A Certified Medicare Planner is going to look at the new plan landscape, the new formularies, and your actual situation and make sure you're still in the right place.

And that's exactly what makes the asymmetry so stark. The downside of having coverage you don't use is essentially nothing. The downside of not having it is potentially hundreds of dollars a year tacked on permanently, plus a year of retail drug costs right when you're at your most vulnerable. Once you put it in those terms, the math really isn't that close.

Right, and he's clearly working toward a fuller view of how all the pieces fit together. Part D is one component. There's a lot more to the Medicare picture than just the drug coverage side, and Ian's been working through it methodically. That's part of why I appreciate how he writes these, he's an engineer, and he treats it like a problem to be solved with clear steps rather than something vague and overwhelming.

It doesn't have to be. When you break it down the way Ian does, piece by piece, number by number, it becomes manageable. The decisions are real, the stakes are real, but the path through them is clear if you have good information and good people in your corner.