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What to do if you unintentionally lost your Medicare Part D coverage.

Category: Changing Medicare Plans
Published: Jul, 13 2023 02:07:12

Sometimes Medicare plan premiums inadvertently do not make it to the plan and unfortunately, even if you unintentionally did not pay your Medicare plan premiums, your Medicare plan has the option of involuntarily disenrolling you from the Medicare plan.

So what should you do if you learn that your Medicare plan premium payments have not been made over the past months? 
Contact your Medicare plan immediately.

The good news is Medicare has implemented safe-guards to protect Medicare beneficiaries who inadvertently missed a premium payment and requires your Medicare plan to contact you about unpaid premiums during the “grace period ”.

If you receive a notification that your Medicare plan premium is unpaid, telephone the Medicare plan’s Member Services department immediately and arrange to make the payments (the toll-free number is on your Member ID card and most printed plan materials).

If you find that you have already been disenrolled from your Medicare plan, you can still contact your plan’s Member Services department and, if you have “good cause” for why your Medicare plan premiums were not paid, ask to pay the unpaid premiums and be reinstated in the plan.  Please click here for more questions and answers related to Medicare plan disenrollment.

Question:  If I pay just a part of my overdue premium, will my partial payment be enough to stop the disenrollment process?

Not necessarily.
  Your partial payment of unpaid plan premiums may not be enough to stop the disenrollment process.  The Medicare manual notes: "While the sponsor may accept partial payments, it has the right to ask for full payment within the grace period .  If the member does not pay the required amount within the grace period, the effective date of disenrollment is the first day of the month after the grace period ends."

Question:  If I pay all of my unpaid Medicare plan premiums after being disenrolled, will the plan then reinstate my Medicare Part D plan coverage?

Not necessarily.  As noted above, without showing good cause after disenrollment, just paying your unpaid premiums will not be enough to get you reinstated back into your Medicare plan.  Instead, you will need to use a valid enrollment period to rejoin your Medicare plan – such as a Special Enrollment Period (SEP) (see "Changing Medicare plans to lower drug costs or increase coverage") or the annual Open Enrollment Period (AEP) that begins on October 15th.

Question:  Can I be disenrolled from my Medicare prescription drug plan if I don’t pay my Part D IRMAA?

  If you are a higher-earning Medicare beneficiary, you can be assessed an Income-Related Monthly Adjustment Amount (IRMAA ) that must be paid in addition to your Medicare Part D premium.

Similar to your monthly premium payments, if you do not pay your Part D IRMAA, your Medicare plan can “involuntarily” disenroll you from your plan and you could be without prescription drug coverage for the remainder of the year.  You can click here to read more about failing to pay Medicare Part D IRMAA.

Remember: You are responsible for Medicare Part D IRMAA payments if you are enrolled in a Medicare prescription drug plan (PDP), a Medicare Advantage plan that includes prescription coverage (MAPD), or if you receive Medicare drug coverage through an employer or union health plan.

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