Can a Medicare Part D plan be reinstated after termination for unpaid premiums if the missed payments were caused by the member’s dementia?

Question

Jeremy Harkins · Accepted Answer

Yes, it may be possible.

Medicare allows a Part D plan to reinstate someone who was dropped for unpaid premiums when there is “good cause” for the missed payments. Dementia can support a good-cause request if the cognitive impairment prevented the member from understanding the bills, managing finances, or arranging for the premiums to be paid.

But the diagnosis by itself does not automatically restore coverage. The plan reviews the circumstances individually.

Act quickly. The member or an authorized representative generally must request reinstatement within 60 days of the disenrollment effective date and explain how the dementia caused the missed payments. The plan may ask for a credible statement or other information supporting what happened.

If good cause is approved, all premiums that were owed when the coverage ended must be paid in full within three months of the disenrollment date. The reinstatement can then restore the Part D coverage without a break.

So I would contact the Part D plan immediately and specifically say: “We are requesting reinstatement for good cause because the member’s dementia prevented the premiums from being paid.”

Have the disenrollment notice, dates of the missed payments, information about the dementia, and details about who was handling the member’s finances available.

The important thing is not to assume the termination is final. There is a Medicare reinstatement process specifically for situations where circumstances outside the member’s control caused the nonpayment.

Sandra Teel · Answer

That's a tough question. It would depend on how many months the premium went unpaid.
Each Part D insurance company has a "grace" period where you can call and make up some payments which can reinstate the plan.  The insurance company does it best to reach out to the client before they terminate the plan. Usually a couple of late payment due notices are mailed. 

Worst case scenario, if the insurance company won't reinstate the plan, you'll have to wait and use the annual enrollment period from Oct 15-Dec 7th to sign up for a new policy which would start the first of the following year.  This would leave the client with a monthly penalty for the months he did not have the coverage.

You might be able to contact Medicare directly to discuss any possible further options in this case.

Susan Ramirez · Answer

Yes. A Part D plan may be able to reinstate the member if the failure to pay premiums was due to dementia or another exceptional circumstance. The member or their representative would need to request reinstatement and provide appropriate documentation.

Answered by Susan Ramirez on October 5, 2026

Agent Licensed in CA

Answered by Susan Ramirez Medicare Insurance Agent

Brett Johnson · Answer

The short answer is maybe. Medicare allows a Part D plan to consider reinstatement for “good cause” when circumstances outside the member's control prevented the premiums from being paid.

Dementia could potentially qualify if it affected the member's ability to understand the notices, make the payments, or arrange for someone else to handle them, but reinstatement is not automatic.

This is not one I would try to solve by guessing or even starting with an agent. I would contact your plans member services, explain the circumstances, and determine what options are available before proceeding.

Lea Vollmer · Answer

Yes, only if you meet specific CMS requirements. You must contact the PDP plan within 60 days of the lapse of payment. You will also need proof and documentation as to why it prevented you from making the payment.

Answered by Lea Vollmer on September 4, 2026

Broker Licensed in IL, AL, AZ & 7 other states

Answered by Lea Vollmer Medicare Insurance Agent

Terri McClinton · Answer

Even though a terminated plan for this reason will not be automatically reinstated by Medicare, an appeal can be filed with the request to reinstate. Don't be afraid to ask for help from a valued agent that knows the ropes of navigating this pitfall.

Answered by Terri McClinton on September 5, 2026

Agent Licensed in PA, GA, MI & NJ, NY, OK & TX

Answered by Terri McClinton Medicare Insurance Agent

Carey Campbell · Answer

Yes.. You will need to utilize Medicares's equitable relief or good cause policies. Reach out to Social Security Admin office for help

Tony Kiepe · Answer

You will have to wait until the next upcoming election period which is October 15 - December 7. I suggest going to Medicare.gov and find a plan that has zero costs and covers all your prescriptions. The expensive plans typically have lower deductibles and cover more prescriptions.

Answered by Tony Kiepe on October 5, 2026

Agent Licensed in WA, AZ, ID & MT

Answered by Tony Kiepe Medicare Insurance Agent

Can a Medicare Part D plan be reinstated after termination for unpaid premiums if the missed payments were caused by the member’s dementia?

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Can a Medicare Part D plan be reinstated after termination for unpaid premiums if the missed payments were caused by the member’s dementia?

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