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cannot initiate the process to disenroll the individual for failure to pay premiums. Plan B must work with CMS to obtain appropriate premium reimbursement.

Further, an enrollee will continue to be considered in premium withhold status if a plan is notified by CMS that the enrollee’s request for premium withholding is not successful as a result of systems or fund transfer issues between CMS and SSA or RRB, or between CMS and the plan. CMS recognizes that in some instances plans have not received premium amounts in their monthly CMS plan payment for enrollees who have elected SSA or RRB withholding. However, plans may not hold enrollees responsible for such issues, nor penalize them by attempting to disenroll them from their plan.

Example – Incorrect Data Due to Systems Miscommunication: An enrollee requests premium withhold and Plan A correctly submits the request to CMS. The transaction request is submitted successfully by CMS to SSA or RRB and the appropriate premium amount is deducted from the enrollee’s SSA or RRB benefit check. However, due to a systems issue between CMS and SSA or RRB, the premium withhold data is not correctly reflected in CMS systems. CMS does not pay the correct premium amount to Plan A. Plan A must work with CMS to obtain appropriate premium reimbursement and may not initiate the disenrollment process for the individual for failure to pay premiums while the premium continues to be withheld.

In addition, plans may not disenroll an individual or initiate the disenrollment process if the plan has been notified that an SPAP, or other payer is paying the Part D portion of the premium, and the plan has not yet coordinated receipt of the premium payments with the SPAP or other payer. (Refer to § 50.6 of Chapter 14 of the Medicare Prescription Drug Benefit Manual for additional information regarding coordination of premium payments).

Part C Policy: Unless the individual elects another MA plan during an applicable election period, any disenrollment processed under these provisions will return the individual to Original Medicare.

60.3.1.1 – Partial Payments 42 CFR § 422.262

While plans may accept partial payments (i.e., less than one month’s premium), it has the right to ask for full payment within the grace period. If the individual does not pay the required amount within the grace period, the effective date of disenrollment or reduction in coverage is the first day of the month after the grace period ends. The plan has the right to take action to collect the unpaid premiums from the individual at any point during or after this process.

60.3.1.2 – Calculating the Grace Period 42 CFR §§ 422.74(d)(1)(i)(B) and 423.44(d)(1)(iii)

Plans must provide enrollees with a grace period that: • Is at least two whole calendar months; • Is a whole number of calendar months and cannot include fractions of months; and