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Plans have additional time beyond the payment deadline (i.e., three months from the disenrollment effective date) to verify payment by the bank and credit the payment to the individual’s account. To provide adequate protections for individuals who make timely payment of their owed amounts, plans have five calendar days beyond the payment deadline to process the payment and notify CMS via CTM. Even if an individual has received a favorable good cause determination, the actual reinstatement will not occur until all required payments are made within three months of the disenrollment effective date.

An individual may not be reinstated in cases where: • The individual pays all Part D-IRMAA amounts (and any plan premium amounts owed) but does not receive a favorable good cause determination. • The individual receives a favorable good cause determination but does not pay the Part D-IRMAA amount (and/or any plan premiums owed) within three months of the disenrollment effective date.

Step 1. A Complaint Tracking Module (CTM) case will be generated for CMS caseworker action. Step 2. The CMS caseworker will review the request and will make a favorable or unfavorable good cause determination. Step 3. The plan must provide documentation, if included in the individual's request, regarding the inability to make timely payment of the Part D-IRMAA, to CMS (through the CMS account manager) so that it may be considered in making the determination. Step 4: If CMS makes an unfavorable determination, CMS will notify the individual of the determination. Step 5. If CMS makes a favorable determination, a notation will be made in the CTM and the CTM will be sent to the plan. Step 6. If a favorable determination is made, plan notification should be sent to the individual and include: (1) Amount owed; (2) Date by which payment must be received for reinstatement; (3) Where to send payment; and/or (4) All payment options available.