Appealing a Part D late enrollment penalty

A late enrollment penalty reconsideration challenges the penalty for a period without qualifying drug coverage. It is a separate process from asking a Part D plan to cover a prescription or reviewing an adverse drug-coverage redetermination. Start with the actual penalty notice and the specific LEP reconsideration form.

Enrollee or appointed representative disputing a Part D late enrollment penalty, using the specific LEP reconsideration form and actual penalty notice. A doctor or other helper must be the representative to request this reconsideration on the enrollee’s behalf. Not a prescription-drug coverage/payment appeal, ordinary plan redetermination/IRE reconsideration, Part C appeal or independent provider reimbursement dispute.

Filing clock: use the penalty letter date

Within 60 days from the date on the letter stating that the enrollee must pay a late enrollment penalty. This is the letter date, not a receipt-based clock. If more than 60 days have passed, the form instructs including a separate explanation of delay; acceptance or an extension is not guaranteed.

Do not substitute the filing period for an ordinary Part D coverage appeal or the time allowed for the reviewer to decide. This reference does not calculate a personal deadline or decide whether a late request will be accepted.

Standard-mail destination

C2C Innovative Solutions, Inc.; Part D LEP Reconsiderations; P.O. Box 44165; Jacksonville, FL 32231-4165

Standard mail only. The form separately lists courier/tracked mail at 301 W. Bay St., Suite 600, Jacksonville, FL 32202 and enrollee fax (833)946-1912. Use the actual current form and notice to choose a channel. The listed portal was not logged into or tested; no operational-portal verification is asserted.

This LEP mailbox ends in 44165. The ordinary Part D drug-coverage IRE route is a different process; do not reuse its 44166 mailbox solely because both references name C2C.

Official CMS-hosted form — CMS-hosted Part D LEP Reconsideration Request Form C2C, PDF page1 IMPORTANT paragraph; PDF page2 standard mail and representative instructions · checked 2026-10-27

Current CMS-hosted guidance checked; form v1.0 does not establish a universal effective date or reconstructed history. Confirm the actual penalty notice and current instructions.

Prepare the administrative handoff

Use one form per enrollee. The form requires the enrollee’s signature; a person requesting reconsideration for the enrollee must have representative authority. Complete and retain the actual form, penalty letter, representation documents when applicable, and copies of supporting evidence in your secure system. Do not upload Medicare numbers, medical records or signed forms to IntelClaim.

The form describes evidence for the circumstances being asserted, such as prior creditable coverage, and says not to send original documents. If coverage status is uncertain, it describes requesting information from the previous plan without waiting for a reply before filing. This page does not decide creditable coverage, enrollment eligibility, a medical-emergency ground or whether the penalty should be removed.

For a prescription-drug coverage denial, use the separate Part D appeal-stage reference. View this LEP directory record. All supported appeal routes.

Prepare, save and export the scoped administrative checklist