The four ringleaders behind the Hatton Garden raid must pay back £27.5 million or each face another seven years in jail.
John "Kenny" Collins, 77, Daniel Jones, 63, and Terry Perkins, 69, are serving seven-year sentences, while Brian Reader, 78, is serving six years and three months in jail, for their roles in the notorious burglary.
Judge Christopher Kinch QC said each jointly benefited from an estimated £13.69 million worth of cash, gold and gems stolen from boxes at Hatton Garden Safe Deposit in London's jewellery quarter after a drill was used to bore a hole into the vault wall.
At a confiscation hearing at Woolwich Crown Court on Tuesday, the men were each ordered to pay millions of pounds based on their "available assets".
If they fail to pay their share of a total of £27.5 million, each will have seven years added onto their current jail sentences, which could mean some of the gang members, who are unwell, could die behind bars.
Handing down his ruling, the judge said: "A number of these defendants are not only of a certain age, but have in some cases serious health problems.
"But as a matter of principle and policy it is very difficult to endorse any approach that there is a particular treatment for someone who chooses to go out and commit offences at the advanced stage of their lives that some of these defendants were."
Collins, of Bletsoe Walk, Islington, north London, was ordered to pay £7,686,039 after the court heard he had assets in "liquid form" and property in this jurisdiction and abroad.
Perkins, of Heene Road, Enfield, was told he must pay £6,526,571.
His barrister Peter Rowlands said Perkins' flat in Portugal would have to be sold, but said his client, who has been diagnosed with severe heart failure, would have to serve the default sentence as there was "no prospect" of any further funds being recovered.
Jones of Park Avenue, Enfield, north London, was ordered to hand over £6,649,827.
His barrister Graham Trembath QC said Jones' only assets were cash in a bank account and he "will have to serve the default term".
Reader, who was not in court, was told he must pay back £6,644,951, including the sale of his £639,800 home and development land worth £533,000.
Tom Wainwright, representing Reader, said his client's sentence "does not have to be very long for it to mean, in reality, he will serve the rest of his life in custody".