Third party payers are typically organizations, municipalities, or other entities
that pay premiums on behalf of a group of beneficiaries. These include:
a state that enrolled a beneficiary under a State Buy-in agreement, as outlined in
HI 00815.000; or
the Office of Personnel Management (OPM).
Determine the recipient of the refund based on whether the excess Medicare premiums
are for months of coverage the beneficiary paid or the third party paid. CMS handles
refunds to third party payers.
In cases where there is an A80022 alert and SSA records indicate payment by the deceased
beneficiary and a third party payer for the same months, pay the excess Medicare premiums
to the deceased beneficiary, or the individual who paid premiums of behalf of the
beneficiary. This is because the third party payer can retroactively pay the Medicare
premiums for the months of coverage that the deceased beneficiary already paid.
Example of premium refund resulting from retroactive payment of premiums by a third party payer: Mr. Dance paid his Medicare premiums for the months of coverage from October 2013
through May 2014. He passes away on May 10, 2014. In August 2014, his state of residence
determines that Mr. Dance was eligible for State Buy-in effective January 2014. The
State paid the Medicare premiums for the months of coverage from January 2014 through
May 2014, resulting in duplicate payments for these months. The state was the proper
payer for the Medicare premiums, and the prior payments made by Mr. Dance for January
through May 2014 are the excess premiums. An A80022 alert generates to refund the
excess Medicare premiums Mr. Dance paid.