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2. The individual has not previously requested reinstatement for good cause during the same 60-day period following the involuntary disenrollment; and 3. The individual shows good cause for failure to pay within the initial grace period; and 4. The individual pays the plan premiums that were owed at the time of disenrollment, in full, within three months of the disenrollment; and 5. The individual establishes by a credible statement that failure to pay premiums within the initial grace period was due to circumstances for which the individual had no control, or which the individual could not reasonably have been expected to foresee; and 6. Where applicable, the individual pays the Part D-IRMAA, that was owed at the time of disenrollment, in full, within three months of the disenrollment.

Reinstatement of enrollment for good cause is provided only in rare circumstances in which the individual or their authorized representative was unable to make timely payment due to circumstances over which they had no control, or they could not reasonably have been expected to foresee. Requests for reinstatement must be accompanied by a credible statement (verbal or written) explaining the unforeseen and uncontrollable circumstances causing the failure to make timely payment. An individual may not make more than one reinstatement request for good cause during the same 60-day period.

Generally, these circumstances constitute good cause:

• A serious illness, institutionalization and/or hospitalization of the individual, or their authorized representative, which lasted for a significant portion of the grace period for the payment of the plan premium or Part D-IRMAA; • Extended illness that is not chronic in nature, a serious (unexpected) complication to a chronic condition or rapid deterioration of the health of the enrollee, a spouse, another person living in the same household, person providing caregiver services to the individual, or the individual’s authorized representative that occurs during the grace period for the payment of the plan premium or Part D-IRMAA; • Recent death of a spouse, immediate family member, person living in the same household, person providing caregiver services to the individual, or the individual’s authorized representative; • Enrollee’s home was severely damaged by a fire, natural disaster, or other unexpected event, such that the individual or the individual’s authorized representative was prevented from making arrangement for payment of the plan premium or Part D-IRMAA during the grace period; • An extreme weather-related, public safety, or other unforeseen event, declared as a federal or state level of emergency, prevented payment of the plan premium or Part D- IRMAA at any point during the grace period. For example, the enrollee’s bank or U.S. Post Office was closed for a significant portion of the grace period; or, • For disenrollments effectuated by CMS for failure to pay Part D-IRMAA, federal government error (i.e., CMS, SSA, or RRB) caused the Part D-IRMAA payment to be incorrect or late, and the enrollee was unaware of the error or unable to take action prior to the disenrollment effective date.