Can I be disenrolled from my Medicare prescription drug plan if I refuse to pay my Medicare Part D IRMAA?

Yes.  If you are a Medicare beneficiary who earns a higher income, you can be assessed both a Medicare Part D and a Medicare Part B Income-Related Monthly Adjustment Amount (IRMAA) that must be paid in addition to your Medicare Part D premium (if you are enrolled in a Medicare prescription drug plan or Medicare Advantage plan that includes drug coverage) and your Medicare Part B premium.

You can read more about the 2026 Part D IRMAA limits on this site

If you do not pay your Part D IRMAA, after a 3-month grace period, Medicare will notify your Medicare Part D plan and your Part D plan can “involuntarily" disenroll you from your Medicare plan - and you can be without prescription drug coverage for the remainder of the year unless you can use a Special Enrollment Period to join another Medicare Part D or Medicare Advantage plan - or you can show "good cause" of why you did not pay your IRMAA on a timely basis (see below for more in Good Cause).

Also, if you lose your Medicare Part D coverage, you may accumulate a permanent late-enrollment premium penalty for every month that you are without some form of creditable prescription drug coverage.

The Centers for Medicare and Medicaid Services (CMS) noted in the Medicare manuals that:

"Individuals with Part D-IRMAA [Part D-Income-Related Monthly Adjustment Amount] must pay this additional [IRMAA] premium directly to the government, not to the plan.  CMS has established a three-month initial grace period before individuals who fail to pay their Part D-IRMAA will be disenrolled from their MA-PD or Part D plan. After the three-month grace period, individuals who fail to pay their Part D IRMAA will be disenrolled from their MA-PD or Part D plan by CMS. CMS will notify the individual’s plan of the disenrollment via the DTRR [Daily Transaction Reply Report]. The disenrollment effective date is the first day of the month after the initial grace period.
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Example: Ms. Jones owes a Part D-IRMAA and has a three-month grace period for premium payment.  CMS bills Ms. Jones her monthly Part D-IRMAA amount, which is due March 1. Ms. Jones does not pay all the Part D-IRMAA amounts owed by the due date of the March bill. On March 7, the plan sends a nonpayment notice to Ms. Jones. She ignores the notice and subsequent monthly bills. Ms. Jones does not make the required payments during the three-month grace period (March, April, May). CMS disenrolls Ms. Jones effective June 1 and sends the plan a specific TRC [Transaction Reply Code] via the DTRR.

The plan must send each affected individual a written notice of the disenrollment within 10 calendar days of receipt of the DTRR indicating disenrollment for nonpayment of the Part D-IRMAA."

(source: Medicare Advantage and Part D Enrollment and Disenrollment Guidance Updated: 2024)


Question:  If you rejoin a Medicare Part D plan, can you be required to pay past-due IRMAA?

Yes.  You can still be required to pay past-due Medicare Part D IRMAA for any unpaid IRMAA you owed when you were enrolled in your Medicare Part D plan.  As noted by the Centers for Medicare and Medicaid Services (CMS):

"If an individual does not have or no longer has Medicare prescription drug coverage, they shouldn’t be charged the Part D-IRMAA.  However, if someone didn’t pay the Part D-IRMAA that was owed before disenrolling from their prescription drug coverage, they are responsible for the past due amount." [emphasis added]

(Source: Part D-Income Related Monthly Adjustment Amount—Frequently Asked Questions & Answers, from Anthony Culotta, Director Medicare Enrollment & Appeals Group, December 10, 2010)

Question:  What is considered Good Cause for not paying IRMAA?

(More about reinstatement into your drug plan for showing "Good Cause" why you did not pay your IRMAA...)

The CMS Medicare manuals note that:

"If an individual has been involuntarily disenrolled for failure to pay either plan premiums (under § 60.3.1) or Part D-IRMAA (under § 60.2.5), they may request reinstatement for good cause... only when:

1. The request is received by the plan or CMS within 60 days of the individual’s disenrollment effective date; and
   
   
2. The individual has not previously requested reinstatement for good cause during the same 60-day period following the involuntary disenrollment; and
   
   
3. The individual shows good cause for failure to pay within the initial grace period; and
   
   
4. The individual pays the plan premiums that were owed at the time of disenrollment, in full, within three months of the disenrollment; and
   
   
5. The individual establishes by a credible statement that failure to pay premiums within the initial grace period was due to circumstances for which the individual had no control, or which the individual could not reasonably have been expected to foresee; and
   
   
6. Where applicable, the individual pays the Part D-IRMAA, that was owed at the time of disenrollment, in full, within three months of the disenrollment."

"Good Cause" generally means that you can show your failure to make timely IRMAA payments was due to unique, unusual, or unexpected circumstances over which you had no control and could not reasonably have been expected to foresee - and such an unusual event most likely will never occur again.

(source: Medicare Advantage and Part D Enrollment and Disenrollment Guidance Updated: 2024)