PROGRAM OPERATIONS MANUAL SYSTEMPart HI – Health InsuranceChapter 002 – Computations/OffsetsSubchapter 08 – Computations/OffsetsTransmittal No. 9, 06/16/2021
Summary of Changes
HI 00208.072 Handling Medicare Advantage (MA) Inquiries and Problem Cases
CAUTION: Do not attempt to provide detailed responses to questions about the Medicare Advantage (MA) program or counsel individuals in their choice of a MA plan.
Refer beneficiaries who request the following printed material to CMS at 1-800-MEDICARE (1-800-633-4227); TTY users call 1-877-486-2048; or to the appropriate website:
Medicare _& You (and Medicare and You, Spanish)
Information on MA MSA plans
List of MA plans available in beneficiary’s area: Medicare Plan Finder
Refer beneficiaries who require assistance in selecting an MA plan to:
CMS at 1-800-MEDICARE (1-800-633-4227); TTY users call 1-877-486-2048 or,
The State Health Insurance Assistance Program (SHIP). Each State has a SHIP which can answer questions concerning health care options and the MA program. Refer to HI 00208.073B for State SHIP telephone numbers.
Beneficiaries who wish to enroll in a MA plan should contact the plan directly to request enrollment with the plan.
Follow the procedures in HI 00801.142 through HI 00801.144 if the beneficiary requests enrollment in Premium - HI.
In all enrollment/disenrollment cases, take the following actions:
Advise the beneficiary to contact the MA plan for resolution.
Beneficiaries may also contact 1-800-MEDICARE (1-800-633-4227); (TTY 1-877-486-2048)
If the beneficiary is unsuccessful and has come into the SSA FO, take a statement from the beneficiary on a Form SSA-795, Statement of Claimant or Other Person explaining the problem. Forward the SSA-795 along with a.screen of the MEQY to the servicing CMS RO. See Center
for Medicare and Medicaid Services website for CMS RO email addresses. FAX all documentation, into NDRed.
If the beneficiary is unsuccessful and has contacted the TSC, take a statement from the beneficiary on Form SSA-5002 Report of explaining the problem. Email the SSA-5002 along with a screen shot of the MEQY to the servicing CMS RO. See Center for Medicare And
Medicaid Services website for CMS RO email addresses. After emailing the material, follow local instructions for dispostion of the SSA-5002.
Any follow-up action needed between CMS and the beneficiary relative to his or her this case is conducted by the CMS RO.