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70.3 – Reinstatements

A reinstatement is a correction made by a plan, CMS (or the RPC) to “reverse” a disenrollment and restore the individual to their enrollment status as if the disenrollment had not occurred. A reinstatement does not require an election period, as it is not a new enrollment request. A reinstatement may be made back to a date when a plan was closed for enrollment. The most common reasons for reinstatements are:

1. Disenrollment due to erroneous death indicator;

2. Disenrollment due to erroneous loss of Medicare Part A or Part B indicator or Part D eligibility;

3. Disenrollment due to erroneous incarceration or unlawful presence information;

4. Individual cancellation of new enrollment;

5. Plan error; or,

6. Demonstration of good cause for failure to pay plan premiums or Part D-IRMAA timely.

CMS (or the RPC) will review requests for reinstatements on a case-by-case basis.

70.3.1 – Reinstatements for Disenrollment Due to Erroneous Death Indicator, Loss of Part A or Part B Entitlement or Loss of Part D Eligibility

When a disenrolled individual contacts the plan to state that they were disenrolled in error and states that they want to remain an enrollee of the plan, the plan should send the individual notification within 10 days, which acknowledges the erroneous disenrollment, and instructs the enrollee to continue to use plan services. Accordingly, plan systems should indicate active enrollment as of the date the plan instructs the individual to continue to use plan services.

Erroneous disenrollments must be corrected and the corresponding reinstatements processed, since the individual remains eligible, regardless of the date on which the individual disputes the erroneous disenrollment or provides evidence of MA or Part D eligibility.

NOTE: CMS will attempt to automatically reinstate individuals that were auto-disenrolled by a report of date of death if there is a subsequent date of death correction that impacts the plan enrollment.

70.3.2 – Reinstatements for Disenrollment Due to Erroneous Incarceration or Unlawful Presence Information

Individuals alleging disenrollment due to erroneous incarceration information or erroneous unlawful presence status must have their complaints reviewed by the plan and possibly referred