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The Social Security Administration (SSA) has released revisions to the Program Operations Manual System (POMS) regarding how to process Part A enrollments that are conditional to a state’s determination of a beneficiary as a Qualified Medicare Beneficiary (QMB).  The update is intended to address inconsistencies and confusion in SSA field offices and includes important clarifications, such as:

  • The conditional enrollment process applies in both Part A Buy-in and Group Payer states.
  • Field Offices should explain the QMB program and conditional enrollment process if an individual lacks premium-free Part A and appears to meet QMB requirements.
  • SSA field offices can add notes to the “Remarks” section of the application and provide a screen shot to the individual so the individual can provide proof of conditional Part A enrollment when applying for QMB through the state.
  • Beneficiaries are allowed to complete the conditional application even if they owe Medicare premiums.
  • In Part A Buy-in states, SSA should process conditional applications on a rolling basis (without regard to enrollment periods), even if the application coincides with the General Enrollment Period.

For more information on QMB status and the Medicare Savings Programs please visit: https://www.medicareadvocacy.org/medicare-info/medicare-savings-programs/.

July 19, 2018 – K. Kertesz

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