TN 55 (02-23)

HI 01001.335 Recovering Unpaid Premiums

Sometimes premiums, which are due, have not been collected before the Supplementary Medical Insurance (SMI) coverage terminates, whether by voluntary request, nonpayment of premiums or death. In these cases, the Centers for Medicare & Medicaid Services will attempt recovery by whichever of the following methods is most readily available: adjustment against monthly benefits payable, request for payment or in certain instances, offset against a survivor's benefit, or direct collection, see HI 01001.335C.

A. Procedure for adjustment against monthly benefits

Uncollected premiums can be adjusted against monthly benefits payable to the beneficiary, including accrued benefits payable after their death, as an underpayment.

B. Procedure for adjustment against survivors benefits

In some cases, a beneficiary may receive monthly benefit payments from which premium amounts should have been but were not deducted. Amounts incorrectly paid to the beneficiary constitute a benefit overpayment and can be adjusted against the lump-sum death payment or against subsequent monthly benefits to which their survivors become entitled on their earnings record (see HI 01001.275).

C. Procedure for direct collection

If premiums cannot be collected readily by any of the methods set forth in sections HI 01001.335A and HI 01001.335B, they will, where feasible, be collected directly from the enrollee or the enrollee's estate. Upon notification of an enrollee's death, the direct billing system sends a one-time Estate bill to the enrollee estate.

When the case involves a very small amount, it will not be practicable to explore the possibility of recovery from an estate by action beyond a request for payment addressed to the survivor, or the filing of a claim if the file identifies a legal representative. (See GN 02215.055 concerning the filing of a claim with a legal representative of an estate.)

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HI 01001.335 - Recovering Unpaid Premiums - 02/02/2023
Batch run: 02/02/2023