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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.

When an enrollee fails to pay both Part D-IRMAA and the plan premium and the disenrollment effective dates are the same, the TRC for the disenrollment action will reflect the first disenrollment transaction that is processed by MARx. If the plan-generated disenrollment transaction, resulting from the failure to pay plan premiums, is processed by MARx before CMS initiates a disenrollment transaction for failure to pay Part D-IRMAA, the TRC will reflect the plan-generated disenrollment.

If the CMS generated disenrollment transaction for failure to pay Part D-IRMAA is processed first, plans will receive the TRC reflecting this action. In these cases, CMS will be unable to process the plan-generated disenrollment transaction because the individual is already disenrolled. When a plan determines that an enrollee was slated for disenrollment due to failure to pay the plan premium and the effective date of the disenrollment matches the Part-D IRMAA disenrollment effective date, plans have three options for notifying enrollees: • Send the notice for failure to pay Part D-IRMAA (see Exhibit 21a); • Send both the notice for failure to pay Part D-IRMAA and the plan notice for failure to pay premiums (see Exhibit 21a); or • Send the plan notice for failure to pay premiums and include information regarding the Part D-IRMAA disenrollment (see Exhibit 21).

Enrollees involuntarily disenrolled from their plan for failure to pay Part D-IRMAA may ask for reinstatement into the plan from which they were disenrolled if the nonpayment of premiums was due to a circumstance that the individual could not reasonably foresee and could not control, such as an extended period of hospitalization. CMS (or an entity acting on behalf of CMS) may reinstate enrollment, without interruption of coverage, if the individual demonstrates good cause and pays the following amounts in full within three calendar months of the disenrollment effective date: • The Part D-IRMAA amounts that caused the disenrollment for nonpayment of Part D- IRMAA; and • Any past due plan premium amounts owed.

For more information on good cause, see § 70.3.5.

60.2.6 – Unlawful Presence Status 42 CFR §§ 422.74(b)(2)(v), 422.74(d)(8), 423.44(b)(2)(vi), and 423.44(d)(8)

SSA determines whether individuals are ineligible for enrollment on the basis of not being lawfully present in the United States. CMS will notify the plan (via DTRR) of an individual’s ineligibility on this basis at the time of enrollment. Plans do not need to investigate to confirm the not lawfully present status of individuals disenrolled by CMS. In addition, plans are not required to continue to provide coverage to individuals contesting their lawfully present status while the issue is under review at SSA.