TN 43 (10-21)

HI 01001.065 Premium Payment Information Furnished to Beneficiary at the Time of Enrollment

A. PROCEDURE - GENERAL

 

Beneficiaries are not asked to pay premiums at the time of enrollment. Instead he/she will be informed, in accordance with the rules in HI 01001.025, that his/her initial premium payment should be made upon receipt of a Medicare Premium Bill (CMS-500) from the Centers for Medicare & Medicaid Services (CMS). It should be pointed out that his/her award notice is not a bill. The beneficiary should receive the first CMS-500 within 30 days after receipt of the award notice. However, if a payment is offered at the time of enrollment, the payment may be accepted. The beneficiary need not pay the premiums. If he/she is unable to pay for some reason, a friend or relative may make the premium payment on his/her behalf (see HI 00805.105 and HI 01001.225). In other cases, the premiums may be paid on a group basis by a lodge, union, employer, or other organization (see HI 01001.230 - HI 01001.270). Refer to HI 00815.088 for payment of premiums by the State under a buy-in arrangement.

B. PROCEDURE - BENEFICIARY INSISTS ON PAYING PREMIUMS IN THE FIELD OFFICE

If the beneficiary insists on making a premium payment at the time of enrollment, payment of premiums in the FO should be discouraged for the reasons given in HI.01001.025.

 

However, if the beneficiary insists on making a premium payment at the time of enrollment, follow instructions in HI 01001.090 Receipt of Premiums in the Field Office (FO).

NOTE:When a beneficiary pays in advance:

  • A CMS-500 will not be sent until their premium liability is $10.00 or more if they are billed directly by CMS for their premiums.

  • When a beneficiary wishes to make an advance premium payment for a quarter, they should make sure the remittance is for the correct amount and return the payment coupon from the CMS-500 with the payment.

  • If the beneficiary doesn’t have their CMS-500 payment coupon, a manual CMS-500 coupon should be created by the FO and sent to the MPCC, to the address below.

NOTE:The Medicare Number must be clearly show on the check/money order. The letters B, I, L, O, S, and Z aren’t used in Medicare Numbers because they are similar to certain numerals.

  • Avoid sending additional items or correspondence other than the payment and CMS-500 coupon

  • Forward all payments to the Medicare Premium Collection Center by close of business the same day to reduce delays as much as possible. The address for MPCC is:

    Medicare Premium Collection Center
    P.O. Box 790355
    St. Louis, MO 63179-0355
  • Please explain to the beneficiary if they choose to pay for two to four quarters at a time, their payment will be applied to their premiums based on the hierarchy of the Medicare premium billing system and not necessarily according to any written documentation sent with their payment.

  • For questions regarding their payment or how it is applied, once it is received, direct them to 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-800-486-2048.

C. PROCEDURE - PAYMENT IN RESPONSE TO A BILL

Billing notices are prepared according to premium information carried in the Direct Billing System (DBS). Premium payments are due by the 25th of the month the bill is mailed.

If beneficiary has made an advance premium payment for a quarter, a subsequent billing notice for future billing will not occur until his/her premium liability is $10.00 or more. However, if the beneficiary submits a payment shortly before the billing selection date, it is likely he/she will receive a billing notice, as the payment is still in the processing stages.

Example: Mrs. Martin, an "M" beneficiary, is on a quarterly "A" billing cycle. She is billed in January. She paid her premiums in February for 8 months (February through September). She should not receive a bill in April. However, her next bill should be sent in July for premiums due for 1 month, October. The due date of all billing notices is the 25th of the month.

Explain to the beneficiary the importance of prompt payment of Supplementary Medical Insurance (SMI) premiums; i.e., payment should be made upon receipt of the bill; and failure to pay premiums timely may result in termination of SMI coverage. Tell the beneficiary when coverage is expected to start and that they may receive the billing notice within 30 days after receipt of the SMI award notification. If the notice or other advice is not received within 60 days after the beginning of SMI coverage, the beneficiary should contact the field office regarding his/her SMI premium billing. Inform the beneficiary about the rules in HI 01001.025 concerning payment by remittance since those rules apply regardless of whether the premium is being paid by the enrollee or by someone on his/her behalf.

Information regarding the grace period should not be provided to the enrollee unless specifically requested. Otherwise, the enrollee may be inclined to put off making the payment until later or may even forget making the payment, causing termination of his/her coverage and loss to the trust fund. In this event, the enrollee loses the real advantage of the long grace period. For example, if an emergency arises which prevents him/her from making payments when due, the enrollee has an extra 2 months, if necessary, in which to catch up.

 


To Link to this section - Use this URL:
http://policy.ssa.gov/poms.nsf/lnx/0601001065
HI 01001.065 - Premium Payment Information Furnished to Beneficiary at the Time of Enrollment - 10/15/2021
Batch run: 10/15/2021
Rev:10/15/2021