A person not yet determined by the State to be a QMB can use the conditional enrollment
process to enroll in Premium-Part A “conditionally.”
The conditional enrollment process allows a person to apply for Premium-Part A but
only get the coverage if the State approves the QMB application, whereby the State
will pay the Part A premiums. If the State denies the QMB application, the person
will not be enrolled in Premium-Part A.
As part of the conditional enrollment process, persons must also apply for Part B
if they are not already enrolled in it. However, Part B enrollments are not conditional.
Part B coverage starts regardless of whether the State approves the individual’s QMB
The conditional enrollment process is necessary because a person must have Part A
in order to qualify for the QMB Program, however, most low-income people who are not
eligible for Premium-Free Part A cannot afford to pay the Part A premium before obtaining
QMB benefits. The conditional enrollment process addresses this problem by allowing
the individual to enroll in Premium-Part A on the condition that the State approves
the person’s QMB application.
In Part A Buy-in States, the conditional enrollment can occur at any time, but in
Group Payer States, the conditional enrollment can only occur during a prescribed
enrollment period, as outlined in HI 00801.133.
Beneficiaries are allowed to complete the conditional application process if they
owe Medicare premiums.
A conditional enrollment in Premium-Part A will not generate a bill. If the State
does not approve the QMB application, the beneficiary will not get Part A coverage.
However, the beneficiary is responsible for paying his or her monthly Part B premiums.
Part B will terminate for non-payment of premiums, as outlined in HI 00820.035.
A person who intends to enroll in Premium-Part A regardless of the State’s QMB determination
will file an application following policies and processes in HI 00801.131 through HI 00801.138.