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Can a Medicare Part D plan disenroll a plan Member if the person doesn't pay their monthly premiums?


Yes.  As noted by the Centers for Medicare and Medicaid Services (CMS), a Medicare Part D or Medicare Advantage plan can disenroll a plan member for non-payment of premiums after proper notice and an appropriate grace period (a minimum of two months).

However, disenrollment for failure to pay plan premiums is optional for each plan, so it's important to review plan materials, or contact the plan directly, to know what the rules are for that plan, including the length of the grace period.

As stated in the Medicare Manuals:

"[If the plan member does not pay their monthly plan premiums,] [t]he [Medicare] Part D {plan] sponsor may:
1. Do nothing, i.e., allow the member to remain enrolled in the same PDP;
2. Disenroll the member after a grace period and proper notice.

If a PDP sponsor chooses to disenroll members for failure to pay premiums, it must apply its disenrollment policy consistently to all members of a plan including applying a consistent grace period of no less than two (2) months. Additionally, the organization must promptly effectuate such disenrollments at the end of the plan’s grace period for payment of premiums.

The PDP sponsor may increase the length of the initial grace period or establish a policy of not disenrolling members for failure to pay the plan premium during the calendar year. For example, a PDP sponsor may increase the grace period from 2 months to 6 months to ease the burden for individuals affected by a natural disaster; however, it must provide this extended grace period to everyone in the [Prescription Drug Plan] and not only those in the area affected by the natural disaster. . . .

If the 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 below). If payment has not been received within a grace period, the individual will be disenrolled."

Plan disenrollment and Automatic premium payments

A Medicare plan cannot disenroll a plan member for failure to pay any outstanding monthly premiums if the member has their plan premium deducted from the Social Security payment (or Railroad Retirement Board benefit check).  If a person elects to have their premium deducted from their Social Security payment, a plan may only disenroll them for failure to pay an outstanding premium after the plan has received notice from Medicare that the deduction from the Social Security payment has ended - and the person has requested direct premium billing. Also, the plan must have billed the member and provided the grace period as well before they can disenroll the member.

CMS notes: "Sponsors may not disenroll members for failure to pay premiums (or notify them of impending disenrollment) in cases where the member has requested that premiums be withheld from his/her Social Security benefit check until the sponsor receives a TRR [CMS Transaction Reply Report] indicating that the member’s request has been rejected. The sponsor must then notify the member of the premium owed, provide the appropriate grace period, and comply with other applicable requirements prior to disenrolling the member.

Sponsors may not involuntarily disenroll any individuals who are considered to be in premium withhold status by CMS. Individuals who have requested premium withhold are considered to remain in premium withhold status until either (1) CMS notifies the sponsor that the premium-withhold request has rejected, failed, or been unsuccessful; or (2) the member requests that he/she be billed directly. Only after one of these actions occurs may a member’s status be changed to “direct bill.” Once the member is considered to be in “direct bill” status, the sponsor must notify the member of the premium owed and provide the appropriate grace period, as described below. Sponsors must always provide members the opportunity to pay premiums owed before initiating any disenrollment action.

However, even if a member’s premium payment status has been changed to “direct bill” and the member can demonstrate that SSA or RRB has withheld Part C and/or Part D premiums during the coverage month(s) in question, the member will be considered to remain in premium withhold status."

(For more information, 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))

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