The Centers for Medicare & Medicaid Services (CMS) collects Supplementary Medical
Insurance based on ESRD(R-SMI) premiums in the same manner as other SMI premiums.
R-SMI coverage ordinarily begins with the first month of hospital insurance based
on ESRD (R-HI). If the beneficiary’s R-HI is retroactive, the R-SMI can also be retroactive
causing difficulty in paying the retroactive R-SMI premiums. The equitable relief
provisions apply to premium arrearage situations of six or more months of retroactive
R-SMI coverage. The Social Security Administration (SSA) informs the beneficiary,
or his or her responsible representative, when there appears to be a six or more month
premium arrearage because he or she has an option of when the R-SMI begins. The beneficiary
has the following options for the R-SMI effective date:
-
•
first month of R-HI if the enrollee elects and is able to pay all the past-due premiums,
-
•
the month of filing for R-HI/R-SMI, or
-
If any of the above situations apply, the equitable relief item on the HIHI screen
in MCS must be “Y”.
If the file does not reflect a clear election for the R-SMI effective date when retroactive
coverage applies, the SMI coverage is prospective (i.e., coverage begins with the
month of processing) and the claimant is notified of his/her right to have earlier
coverage.
SSA can amend the SMI award to give retroactive coverage if we receive a timely request
and payment.