DI 12027.035 Statutory Benefit Continuation (SBC) in Election of Medicare–Only Cases

A. Policy – SBC in Election of Medicare-Only Cases

A ceased beneficiary who appeals the medical cessation may request SBC of only Medicare coverage without also requesting SBC cash benefits.

NOTE: SBC does not apply to Medicare Qualified Government Employees (MQGE) only cases.

•

The beneficiary may elect SBC of both Parts A and B or only Part A or Part B.
•

An individual who was entitled to Part A only at the time of his/her disability entitlement may enroll for Part B coverage only during the General Enrollment Period (GEP) of January through March, with entitlement effective the first month after the month of the GEP enrollment. Therefore, where an individual elects Medicare-only, then only the Medicare coverage that was in effect as of the date of disability termination will continue.

The field office (FO) will:

•

Provide a copy of the election statement to the beneficiary.
•

Fax the signed election statement (SSA-795) into section E of the electronic folder (EF), if the official folder is electronic. Verify the document is in the EF and shred the original per DI 81020.055.
•

Place the signed election statement (SSA-795) in the blue section of the Modular Disability Folder (MDF), if the official folder is paper.

a.

Inform the beneficiary that he/she will be billed directly for the Part B premium and if not paid, Part B entitlement will be terminated.
b.

See DI 12027.010C.
c.

Process the appeal request in the routine manner.

a.

Notify the appropriate Processing Center (PC) to request termination of benefits and MBR update to show continuation of Medicare only.
b.

See DI 12027.010C.
c.

Process the appeal in the routine manner.

NOTE: Additional information specific to this topic exists in Medicare Continuation During Appeal of Title II Disability Cessation, HI 00801.161.

DI 12027.035 - Statutory Benefit Continuation (SBC) in Election of Medicare–Only Cases - 09/11/2023
Batch run: 09/11/2023
Rev:09/11/2023