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

Sandra Teel · Accepted 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.

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

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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