If an individual has not paid his or her installment premiums up-to-date when the
next installment is due, the PSC technician will notify the individual that the missing
premium must be remitted within 30 days or the period of SMI entitlement covered by
the installment agreement will be removed as a period of coverage (see HI 00805.180D.) The individual must remit the current installment payment as well as the missing
installment payment within 30 days of the notice.
The PSC technician will:
control the case for 45 days for termination action if the installment has not been
received. A notice using this language must be sent to the beneficiary explaining
the consequences of not remitting the premium prior to the time limit.
“Our records show that you have failed to remit the installment due in MM/YYYY for
the Supplementary Medical Insurance premium payments you owe for the period of MM/YYYY
As we previously informed you, the installments must be paid timely in order for you
to retain the entitlement for the period covered by the installments. If we do not
receive the past due installment within 30 days, you will not have Supplementary Medical
Insurance for the period of MM/YYYY to MM/YYYY. We will refund you any premium installments
you have already made for this period. If medical bills have been paid for these months,
you must repay the money to the Centers for Medicare and Medicaid Services (CMS).
We are enclosing a premium bill for $$$.¢¢. This includes the past due installment
of $$¢¢ and the current installment of $$$.¢¢.”;
prepare a Form CMS-500 (Notice of Medicare Premium Payment Due) by entering the total
amount of the past due installment payment due, or instructions to complete the CMS-500;
if the past due installment payment has not been received after 30 days have expired,
terminate the period of SMI coverage equal to the first month of retroactive SMI covered
under the installment agreement. Record a subsequent occurrence of SMI equal to the
first month of entitlement after the period covered under the installment agreement.
A BIC T beneficiary had Part A and B entitlement beginning January 2005. It was determined
that for the period of February 2006 to December 2006 that no bills were sent due
to government error. The claimant agreed to pay $40.00 a month until the arrearage
was paid. Therefore, his arrearage continued from January 2005, as well as the billing.
The installment premium for January 2007 was not received within 30 days from receipt
of the notice. The Part B is terminated February 2006 for non-payment of premiums.
A subsequent occurrence of Part B coverage will be recorded effective January 2007.
Part A coverage will continue from January 2005. See SMI Equitable Relief Code (EQUIT
RELIEF) in SM 00850.150.