Award Part B prospectively beginning the month we process the award (i.e., current operating month (COM)), if the beneficiary owes six or more months of retroactive premiums at the time we finally notify them about the start of Part B coverage.

• •

  Do not include the premium for the COM nor future months of coverage

• •

  Notify the enrollee of the option to choose the earliest possible entitlement date, and that the retroactive premiums are paid or deducted from benefits.

• •

  If an enrollee elects the earlier coverage date, the enrollee must notify us in writing within 60 days of the date on the notice and pay all premiums due.

  NOTES:

• •

  To calculate the late enrollment penalty for late filing: Do not count the months between the end of the enrollment period that the enrollee filed the request (or deemed filed) and the Part B entitlement date.

• •

  Beneficiaries may pay retroactive premiums in installment payments. For establishing installment plans, see HI 008030.060 .

The beneficiary may only chose coverage to start at:

• •

  COM or

• •

  The earliest possible entitlement date

The beneficiary cannot choose any other date for coverage to begin. This protects the Part B Trust Fund from substantial expenses by the beneficiary choosing to only have Part B coverage begin when the beneficiary had numerous or costly services.

Begin the coverage and premium liability with the month we take final action to award the claim or, if the beneficiary requests retroactive coverage, the date provided by the initial enrollment period (IEP) in HI 00805.165.

• •

  Enrollee wants only current coverage

  • –

    Award Part B beginning COM according to section B.2. Do not include retroactive coverage language (i.e., do not include equitable relief paragraph mentioned in section B.2.b).

• •

  Enrollee wants the earliest date and is willing to pay the past premiums

  • –

    Award Part B according to section B.3.

Follow these procedures when the beneficiary does not request either

• •

  current month Part B coverage only or

• •

  the earliest possible enrollment date.

When the beneficiary makes no definitive request for their Part B coverage start date, as outlined in section B.1., refer to the default process outlined below.

1. a. 

   Award coding.
   
   Follow the procedures in the chart in this section B.2.b to notify the beneficiary that we are providing relief.

2. b. 

   Notice of award
   
   Send the enrollee a notice of current Part B award (or earlier, proper month according to State buy-in) which includes:

• •

  Required language stating the current entitlement dates and premium rates, similar to:

  • –

    You are entitled to Medicare Part B (medical insurance) beginning (date).

  • –

    We charge a monthly premium for your Medicare Part B medical insurance. Your monthly Medicare Part B premium is $XX.

Universal text options for entitlement and premium rates are in NL 00720.145 and NL 00720.180 respectively.

• •

  The beneficiary can choose to have Part B coverage begin with the first month of eligibility. This is the date coverage would have begun if we processed the enrollment request correctly and promptly. The beneficiary in current pay must pay or have deducted from monthly benefits past due Part B premiums. For more information on coverage period starts dates, see HI 00805.165 .

  • –

    Use the chart in this section.

Universal text options for equitable relief paragraphs for the scenarios in the chart are in NL 00720.180.

• •

  If Part A is retroactive, determine if the Medicare Awards with Retroactivity paragraph is necessary according to section B.3.b.

  Scenario	Follow coding in:	Required language similar to:
  Delays in awards (UTI HIB252)	SM 00850.150	If you want Part B to start earlier, you can choose to have it start in <earlier date>. If you want this benefit to start earlier, you must do the following within 60 days after the date of this notice: – tell us in writing that you want the Part B coverage beginning <earlier date>; – pay us <$> (This covers the premiums due from <earlier date> through <date of COM >; or,
  ​	​	– tell us we can withhold this amount from your monthly benefit payment If you want the Part B benefits beginning <earlier date> but find it hard to pay the premium amount in a lump sum, ask us about other ways to pay the money.
  Delays in awards that span over variable SMI year(s) according to HI 01001.004D (UTI HIB249)	SM 00850.150	If you want your Medicare Part B (medical insurance) to start earlier, you can choose to have it start in (earlier date). To start your Part B earlier, you must do the following things within 60 days after the date of this notice: – tell us in writing that you want medical insurance beginning (earlier date); AND – pay us ($) or tell us we can withhold this amount from your check. This amount covers the premiums due from (earlier date) through (date to close gap). If you would find it hard to pay the premium amount you would owe in a lump sum, ask us about other ways to pay the premiums. If you choose to have your Part B start in (earlier date), your current monthly premium will be (variable premium). If you do not choose the earlier date, your monthly premium will be (current standard Part B premium).
  Delays in resumptions for granting relief under HI 00805.185 (UTI HIB231)	HI 00830.030	We apologize for any inconvenience caused by our error. The mistake has been corrected, and your Part B coverage will resume (COM -MM/YY).. It might be to your advantage to start your Part B coverage at an earlier date. We can start the coverage beginning <termination date>. However, if you want Part B coverage to start earlier, you have to pay the premiums for this coverage. The total amount of premiums from <termination date> through <month before current operating month> is ($). If you want Part B coverage to start on the earlier date, within 60 days after the date of this notice you must: – Tell us in writing that you want the Part B coverage beginning <earlier date> – Pay us <$> (This covers the premiums due from <earlier date> through <date of COM >; or, – Tell us we can withhold this amount from your monthly benefit payment. If you want the Part B coverage to start on the earlier date, but find it hard to pay the premium amount in a lump sum, ask us about other ways to pay .
  Delays in resumptions for erroneous terminations under HI 00805.215 (UTI HIB231)	HI 00830.030	Same as in “Delays in resumptions for granting relief under HI 00805.185 scenario.

If the enrollee is requesting the earlier entitlement date, ask whether they are willing to pay the past premiums before you take any award action.

1. a. 

   Award Coding
   
   If the enrollee wants the Part B coverage to be at the earliest date or continuous, they must pay the premiums according to the guidelines in HI 00805.180.
   
   If the enrollee meets the requirements, adjust the award to show the earlier starting date of coverage. Review the case after the award as outlined in SM 00711.000.

   Scenario - If the enrollee:	Follow coding in:
   pays the retroactive premiums in full as a lump sum see GN 02403.030A.4	SM 00850.560D.3.e NOTE , and SM 00850.445 , SM 00848.390 (or SM 00848.340 if applicable)
   agrees to installments and is currently billed for premiums also known as the HOTFILE	HI 00830.060D
   agrees to benefit deductions and is in current pay	HI 00830.060C, SM 00850.560, SM 00850.570, SM 00850.580

2. b. 

   Notice of award and special paragraph for awards or reinstatements involving retroactivity
   
   We require special language for awards or reinstatements involving retroactivity. Beginning January 1, 2010, providers and suppliers must file all Medicare Part A and Part B claims for payment of services to the appropriate Medicare claims processing contractor no later than 12 months or one calendar year, after the date the service was furnished.
   
   Medicare has an exception that extends the time limit in the following situations:

   • •

     Part A, Part B, or entitlement to both does not exist at the time the beneficiary received the service, and

   • •

     The beneficiary receives notice of Part A or Part B entitlement effective retroactively to or before the date of the furnished service.

   When the beneficiary meets these criteria, the provider or beneficiary has six months from the date, they receive the notice of the retroactive award to submit the claim for payment.

   Send the enrollee a notice of Medicare award, which includes: Required language in all notices to state current dates of entitlement and premium rates; see section B.2.b.

• •

  Required language in all notices to state current dates of entitlement and premium rates; see section B.2.b.

• •

  Include the universal text identifier (UTI) Medicare Awards with Retroactivity in the notice of award or reinstatement when the retroactivity of Medicare enrollment is 6 or more months.
  
  For retroactive awards: Determine if you must include the Medicare Awards with Retroactivity UTI using the steps in the chart in this section.