Identification Number:
HI 00208 TN 9
Intended Audience:See Transmittal Sheet
Originating Office:Centers for Medicare & Medicaid Services (CMS)
Title:Computations/Offsets
Type:POMS Transmittals
Program:Medicare,Medicaid
Link To Reference:
 

PROGRAM OPERATIONS MANUAL SYSTEM
Part HI – Health Insurance
Chapter 002 – Computations/Offsets
Subchapter 08 – Computations/Offsets
Transmittal No. 9, 06/16/2021

Audience

PSC: CA, CS, ICDS, IES, ISRA, PETE, RECONR, SCPS, TSA, TST;
OCO-OEIO: CR, EIE, FCR, PETL, RECONR;
OCO-ODO: BET, BTE, CCE, CR, CST, CTE, CTE TE, DEC, PAS, PETE, PETL;
FO/TSC: CS, CS TII, CSR, CTE, FR, OA, RR, TA, TSC-CSR;

Originating Component

CMS

Effective Date

Upon Receipt

Background

 

Summary of Changes

HI 00208.072 Handling Medicare Advantage (MA) Inquiries and Problem Cases

 

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.

A. Procedure — MA inquiries

1. Beneficiaries requesting printed material

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

2. Selecting an MA plan

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.

3. Beneficiaries requesting enrollment

Beneficiaries who wish to enroll in a MA plan should contact the plan directly to request enrollment with the plan.

B. Procedure — MA enrollment/disenrollment cases

1. Enrollment in Premium - HI

Follow the procedures in HI 00801.142 through HI 00801.144 if the beneficiary requests enrollment in Premium - HI.

2. All enrollment/disenrollment cases

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.

C. Process — CMS RO-Handling problem cases

Any follow-up action needed between CMS and the beneficiary relative to his or her this case is conducted by the CMS RO.


HI 00208 TN 9 - Computations/Offsets - 6/16/2021