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into the plan. Mr. Smith pays the amount due on June 15. Mr. Smith is reinstated into the plan. (Note: If Mr. Smith did not pay his owed amount by June 30, he would not be reinstated.)

Example 2: Mr. Smith is disenrolled by the plan for failure to pay plan premiums on July 1 (after the plan’s required grace period expired). Mr. Smith mails in his past due premium payment amount to the plan on July 30. He contacts the plan and makes his request for reinstatement on August 10 and does not receive a favorable good cause determination. Mr. Smith may not be reinstated.

Example 3: Mr. Smith is disenrolled by the plan for failure to pay plan premiums on November 1 (after the plan’s required grace period expired). Mr. Smith mails in his past due premium payment amount to the plan on December 15 but does not contact the plan to request reinstatement. Because Mr. Smith does not have a favorable good cause determination, he may not be reinstated.

Unfavorable Determinations If the plan makes an unfavorable determination, the plan should notify the individual of this decision, by phone or in writing, within three business days of making the determination.

NOTE: In cases where the involuntary disenrollment for failure to pay plan premiums is the result of plan error, plans should follow the reinstatement process outlined in § 70.3.4. Plans should not refer these individuals to 1-800-MEDICARE, nor should these cases be considered for reinstatement for good cause.

70.3.5.2 – Process for Good Cause Determinations for Nonpayment of Part D-IRMAA

When a disenrolled individual contacts the plan following disenrollment for failure to pay Part D-IRMAA and indicates that they “have a good reason for not paying the Part D-IRMAA,” the plan must advise the individual to contact 1-800-MEDICARE (1-800-633-4227; TTY: 1-877- 486-2048) within 60 calendar days of the disenrollment effective date to make the good cause reinstatement request.

Once a request is made with CMS via 1-800-MEDICARE: