q1medicare.com
Powered by Q1Group LLC
A non-government resource for the Medicare community
Powered by Q1Group LLC
A non-government Medicare community resource
  • Menu ☰
  • Home
  • Contact
  • MAPD
  • PDP
  • 2025
  • FAQs
  • Articles
  • Search ⌕
  • Contact
  • 2025
  • FAQs
  • Articles
  • Latest Medicare News
  • Search ⌕

How does the unpaid-premium grace period work for Medicare Part D plans?

Category: Living with your Part D plan
Updated: Apr 11, 2025
< Previous
Next >
The Centers for Medicare and Medicaid Services (CMS) have implemented safe-guards to protect Medicare beneficiaries who inadvertently missed a Medicare Part D premium payment and require Medicare plans to contact plan members about the unpaid premiums and provide "a consistent grace period of no less than two (2) months".

The Medicare Advantage and Part D Enrollment and Disenrollment Guidance (Updated: 2024), Section 60.3.1.2 – Calculating the Grace Period 42 CFR §§ 422.74(d)(1)(i)(B) and 423.44(d)(1)(iii), states:

"Plans must provide enrollees with a grace period that:
  • Is at least two calendar months;
  • Is a whole number of calendar months and cannot include fractions of months; and
  • Begins on the first day of the month for which the premium is unpaid, or the first day of the month following the date on which the plan bills the enrollee for the actual premium amount due, whichever is later.

NOTE: For individuals who have requested communications in an accessible format, the notification of unpaid premiums (e.g., the bill) are not considered delivered, and thus the grace period cannot begin until the organization fulfills its legal obligation, under Section 504 of the Rehabilitation Act of 1973, to provide the notification in an accessible format."

However, some plans may provide a grace period that is longer than two months.
"Example A: Plan XYZ has a 2 month grace period for premium payment. Plan member Mr. Stone’s premium was due on February 1.  He did not pay this premium and on February 7th, the PDP sponsor sent an appropriate notice. Mr. Stone ignores this notice and any subsequent premium bills. The grace period is the months of February and March. If Mr. Stone does not pay his plan premium before the end of March, he will be disenrolled as of April 1.

Example B:  Plan QRS has a 3 month grace period for premium payment.  Plan member Mrs. Monsoon’s premium was due on July 1.  She did not pay this premium and on July 6th, the PDP sponsor sent an appropriate notice.  Mrs. Monsoon ignores this notice and subsequent premium bills.  The grace period is the months of July, August and September. If Mrs. Monsoon does not pay her owed premiums by the end of this period (September 30), she will be disenrolled effective October 1.

The [Medicare Part D plan] sponsor must state that it requires the member to make full payment within the grace period, and pay all premiums falling due within that period, in its initial delinquency notice to the member if it chooses this policy."



Source:
Medicare Advantage and Part D Enrollment and Disenrollment Guidance Updated: 2024
Medicare Prescription Drug Benefit Manual, Chapter 3 - Eligibility, Enrollment and Disenrollment, Updated: August 19, 2011, (Revised: August 15, 2023)

Also see:



FAQ Home
< Previous   Next >



Medicare Supplements
fill the gaps in your
Original Medicare
1. Enter Your ZIP Code:
» Medicare Supplement FAQs


Browse FAQ Categories
Q&A of the Day
Help! Where Do I Start?
General Medicare Part D (PDPs and MAPDs)
Medicare Advantage plans (MAPD)
Medicare Supplements or Medigap
Medicare Medical Savings Account plans (MSA)
Choosing a Medicare plan
Star Ratings & Medicare plan quality
Medicare Part D enrollment
ANOC: Annual plan changes
Changing Medicare Part D plans
Medicare Enrollment Periods (IEP & AEP)
Special Enrollment Periods (SEPs)
Medicare plan disenrollment
Late-Enrollment Penalty (LEP)
Initial Deductible
Cost-sharing: What You Pay
Paying your premiums
Medicaid, LIS, & Extra Help
IRMAA: Higher incomes and costs
Living with your Part D plan
Explanation of Benefits (EOB)
Pharmacies and Part D
Retail drug pricing
Straddle Claims
Understanding your Formulary
Monthly Formulary changes
Drug Usage Restrictions (QL, PA, ST)
Formulary Exceptions (Coverage Determinations)
Transition fills
Coverage of specific drugs
Insulin and diabetic supplies
Catastrophic Coverage
Out-of-Pocket: TrOOP, RxMOOP, and MOOP
Specific healthcare coverage
Supplemental Benefits
Your healthcare network
Medicare plan providers
Traveling with your Medicare plan
Moving and Medicare Part D
Drug Discount cards
Using Part D with other drug programs
VA and TRICARE coverage
Employer drug coverage
General Medicare
New Medicare cards
Medicare Part B
Medicare Set Aside arrangements
Medicare and the ACA Marketplace
Online Tool Tips
Other Q1Medicare tips and questions
Archive
Archive: The Donut Hole or Coverage Gap
Archive: Entering the Donut Hole
Archive: Donut Hole Discounts
Archive: Closing the Coverage Gap
Archive: Exiting the Donut Hole


Pets are Family Too!
Use your drug discount card to save on medications for the entire family ‐ including your pets.

» Learn more about savings on Pet Medications
  • No enrollment fee and no limits on usage
  • Everyone in your household can use the same card, including your pets
Your drug discount card is available to you at no cost.


© Q1Group LLC 2005 - 2025  



Tips & Disclaimers
  • Q1Medicare®, Q1Rx®, and Q1Group® are registered Service Marks of Q1Group LLC and may not be used in any advertising, publicity, or for commercial purposes without the express authorization of Q1Group.
  • The Medicare Advantage and Medicare Part D prescription drug plan data on our site comes directly from Medicare and is subject to change.
  • Medicare has neither reviewed nor endorsed the information on our site.
  • We provide our Q1Medicare.com site for educational purposes and strive to present unbiased and accurate information. However, Q1Medicare is not intended as a substitute for your lawyer, doctor, healthcare provider, financial advisor, or pharmacist. For more information on your Medicare coverage, please be sure to seek legal, medical, pharmaceutical, or financial advice from a licensed professional or telephone Medicare at 1-800-633-4227.
  • We are an independent education, research, and technology company. We are not affiliated with any Medicare plan, plan carrier, healthcare provider, or insurance company. We are not compensated for Medicare plan enrollments. We do not sell leads or share your personal information.
  • Benefits, formulary, pharmacy network, provider network, premium and/or co-payments/co-insurance may change on January 1 of each year. Our PDPCompare.com and MACompare.com provide highlights of annual plan benefit changes.
  • The benefit information provided is a brief summary, not a complete description of benefits. For more information contact the plan.
  • Limitations, copayments, and restrictions may apply.
  • We make every effort to show all available Medicare Part D or Medicare Advantage plans in your service area. However, since our data is provided by Medicare, it is possible that this may not be a complete listing of plans available in your service area. For a complete listing please contact 1-800-MEDICARE (TTY users should call 1-877-486-2048), 24 hours a day/7 days a week or consult www.medicare.gov.
    Statement required by Medicare:
    "We do not offer every plan available in your area. Any information we provide is limited to those plans we do offer in your area. Please contact Medicare.gov or 1-800-MEDICARE to get information on all of your options."
  • When enrolling in a Medicare Advantage plan, you must continue to pay your Medicare Part B premium.
  • Medicare beneficiaries with higher incomes may be required to pay both a Medicare Part B and Medicare Part D Income Related Monthly Adjustment Amount (IRMAA). Read more on IRMAA.
  • Medicare Advantage plans that include prescription drug coverage (MAPDs) are considered Medicare Part D plans and members with higher incomes may be subject to the Medicare Part D Income Related Monthly Adjustment Amount (IRMAA), just as members in stand-alone Part D plans. In certain situations, you can appeal IRMAA.
  • You must be enrolled in both Medicare Part A and Part B to enroll in a Medicare Advantage plan. Members may enroll in a Medicare Advantage plan only during specific times of the year. Contact the Medicare plan for more information.
  • If you are enrolled in a Medicare plan with Part D prescription drug coverage, you may be eligible for financial Extra Help to assist with the payment of your prescription drug premiums and drug purchases. To see if you qualify for Extra Help, call: 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048, 24 hours a day/ 7 days a week or consult www.medicare.gov; the Social Security Office at 1-800-772-1213 between 7 a.m. and 7 p.m., Monday through Friday. TTY users should call, 1-800-325-0778; or your state Medicaid Office.
  • Medicare evaluates plans based on a 5-Star rating system. Star Ratings are calculated each year and may change from one year to the next.
  • A Medicare Advantage Private Fee-for-Service plan (PFFS) is not a Medicare supplement plan. Providers who do not contract with the plan are not required to see you except in an emergency.
  • Disclaimer for Institutional Special Needs Plan (SNP): This plan is available to anyone with Medicare who meets the Skilled Nursing Facility (SNF) level of care and resides in a nursing home.
  • Disclaimer for Dual Eligible (Medicare/Medicaid) Special Needs Plan (SNP): This plan is available to anyone who has both Medical Assistance from the State and Medicare. Premiums, co-pays, co-insurance, and deductibles may vary based on the level of Extra Help you receive. Please contact the plan for further details.
  • Disclaimer for Chronic Condition Special Needs Plan (SNP): This plan is available to anyone with Medicare who has been diagnosed with the plan specific Chronic Condition.
  • Medicare MSA Plans combine a high deductible Medicare Advantage Plan and a trust or custodial savings account (as defined and/or approved by the IRS). The plan deposits money from Medicare into the account. You can use this money to pay for your health care costs, but only Medicare-covered expenses count toward your deductible. The amount deposited is usually less than your deductible amount, so you generally have to pay out-of-pocket before your coverage begins.
  • Medicare MSA Plans do not cover prescription drugs. If you join a Medicare MSA Plan, you can also join any separate (stand-alone) Medicare Part D prescription drug plan
  • There are additional restrictions to join an MSA plan, and enrollment is generally for a full calendar year unless you meet certain exceptions. Those who disenroll during the calendar year will owe a portion of the account deposit back to the plan. Contact the plan provider for additional information.
  • Medicare beneficiaries may enroll through the CMS Medicare Online Enrollment Center located at www.medicare.gov.
  • Medicare beneficiaries can file a complaint with the Centers for Medicare & Medicaid Services by calling 1-800-MEDICARE 24 hours a day/7 days or using the medicare.gov site. Beneficiaries can appoint a representative by submitting CMS Form-1696.
.