If a person is disenrolled from their Medicare Part D or Medicare Advantage plan for failure to pay their monthly premiums and wants to re-enroll in their Medicare Part D plan during an available enrollment period (such as the annual Open Enrollment Period (AEP) or during a Special Enrollment Period (SEP)), then their Medicare plan may require them to pay any outstanding premiums owed to the plan before accepting the new enrollment request.
Question: Will a Medicare plan give me notice of my unpaid premiums before disenrolling me?
Yes. Before someone is disenrolled from their Medicare Part D plan for failure to pay monthly premiums, the Medicare plan must provide their plan Members with adequate notice of unpaid premiums, and have a grace period of no less than two (2) months to repay unpaid premiums.
As noted by Medicare:
"If the [Medicare Part D or Medicare Advantage plan] sponsor chooses to disenroll the member, this action
may only be accomplished by the sponsor after the sponsor makes a reasonable
effort to collect the payment and notice has been provided to the member (as
described [in the Medicare Manual]). If payment has not been received within a grace period, the
individual will be disenrolled."
, if a person fails to pay their monthly premiums, and the plan provides proper notice of the overdue premium payments, and the person is disenrolled from their Medicare Part D plan - the person can repay the unpaid premiums - and rejoin the same Medicare Part D plan during the next annual Open Enrollment Period
(AEP) that begins October 15 and continues through December 7th - or by using any available Special Enrollment Period
Question: Can I be reinstated in my Medicare plan by just repaying my unpaid monthly premiums - even though we are outside of the AEP?
Maybe - but only if you can show "good cause" of why you did not pay your premiums - or have an SEP.
If a person was disenrolled from their Medicare Part D plan for
non-payment of their monthly plan premiums, the person must show "good cause
" of why they failed to make their premium payments - even after they have repaid the past premiums within the specified time.
In general, reinstatement for "Good Cause" occurs only when a person's failure to make timely premium payment was due to
unique, unusual, or unexpected circumstances over which they had no control and could not
reasonably have been expected to foresee and such an event most likely will never occur again.
The Medicare Manual provides several examples of "circumstances that do not constitute good cause [including]
that bills or warning notices were not received due to unreported
change of address, out of town for vacation, visiting out of town
- Authorized representative did not pay timely on member’s behalf;
- Lack of understanding of the ramifications of not paying plan premiums or Part D-IRMAA;
- Could not afford to pay premiums during the grace period;
- Need for prescription medicines or other plan services." [emphasis added]
Please click here to read more about being reinstated into your Medicare Part D plan by showing Good Cause:
Question: What happens if I cannot show good cause to be reinstated?
You probably will not able to rejoin the Medicare plan outside of a
valid enrollment period. If a person has repaid their unpaid premiums, but cannot show
"Good Cause", then they probably will not
reinstated into their Medicare plan. As noted above, the person may be
able to re-enroll into the Medicare plan during the annual Open
Enrollment Period (AEP) or by using a Special Enrollment Period - such
as the 5-star Special Enrollment Period
that allows you a once-a-year opportunity to join a Medicare Part D
plan or Medicare Advantage plan that has a 5-star quality rating.
You can click here for a few other common Special Enrollment Periods (SEPs)
As reference, please see:
Medicare Prescription Drug Benefit Manual, Chapter 3 - Eligibility,
Enrollment and Disenrollment, Updated: August 19, 2011, (Revised:
November 16, 2011, August 7, 2012, August 30, 2013, August 30, 2014,
July 6, 2015, September 1, 2015, September 14, 2015 & December 30,
2015, May 27, 2016, August 25, 2016, June 15, 2017, July 31, 2018 &
August 12, 2020))
Please also see: