There are a number of circumstances in which a Medicare enrollee may owe back Medicare premiums. A very common example of when an enrollee may face a past-due Medicare premium is when they lose Medicaid coverage that helps pay for Medicare premiums. For another example, an enrollee leaving incarceration may see a past-due Medicare premium because their Part B premium continued to be billed for a few months while they were incarcerated.
When an individual owes back Medicare premiums, that amount can be deducted from their monthly Social Security check. Because the amount deducted can be for months of back premiums, it can be costly and cause immediate financial distress. There are options available to enrollees who owe back Medicare premiums that can help reduce or even eliminate the amount that needs to be paid back. These options include requests for installment plans, requests for waivers, or appealing determinations. An individual can pursue multiple options at the same time, including challenging the past-due amounts or asking for an installment plan option.
How can a person request an installment plan payment option?
Individuals can request a payment plan to pay down their past-due Medicare premiums.[1] Monthly payments can be as low as $15 if the past-due Medicare premium is $630 or less; otherwise, the monthly payment will be higher. The monthly installment payment must be high enough to pay back the past-due amount within 42 months.[2]
An installment payment plan agreement can be requested by calling the Social Security Administration (SSA) at 1-800-772-1213 or contacting the local Social Security Administration (SSA) field office. When contacting SSA, the Medicare enrollee can request an installment plan agreement and state that they are unable to pay the past-due Medicare premium as a lump sum.
Importantly, under this installment payment plan option, the amount of past-due Medicare premiums already paid (including money taken out of Social Security checks) can be refunded to the individual in a matter of days after the request.
Example
Ms. Oh recently lost Medicaid coverage because she did not receive her annual redetermination forms to complete. She received a notice from SSA that she owes two months of Medicare Part B premiums ($185) totaling $370, and her monthly Social Security Retirement check of $1,200 was reduced by $370 to pay for that back premium, plus $185 for that month’s premium. Ms. Oh called Social Security (1-800-772-1213) and requested an installment payment plan. The SSA refunded Ms. Oh $355 (which equals two months of her Medicare Part B premiums, minus $15 for the first installment payment), and reduced her Social Security Retirement check by $15 per month going forward.
How can an individual request a waiver for extreme hardship?
Individuals can use SSA Form 632 to request a waiver for extreme hardship.[3] Individuals with Supplemental Security Income (SSI) should be granted a waiver, along with others who demonstrate extreme hardship (even if they are not on SSI). A waiver process can be started by calling SSA (1-800-772-1213) or contacting the local SSA field office. Under this waiver option, the amount owed in back Medicare premiums is eliminated and the amount of past-due Medicare premiums already paid (including money taken out of Social Security checks) can be refunded.
Practice Tip
The time it takes SSA to refund money under a waiver may take longer than the amount of time it takes SSA to refund money under an installment plan. Individuals can request both an installment plan and a waiver at the same time.
Practice Tip
SSA is adding additional resources to the online portal, mySocialSecurity account, so it may be possible to file a request for waiver online. Keep any materials showing when the waiver request was submitted in case there is an issue with SSA reviewing the online waiver request in a timely fashion.
How can an individual challenge a Medicaid decision?
An individual may owe Medicare back premiums due to an incorrect Medicaid decision. One example is improper termination of their Medicare Savings Program (MSP). In that case, the individual can file an appeal with their state Medicaid agency, seek a reinstatement of their application, and/or reapply for coverage.[4]
Example
Ms. Oh, who sought an installment plan when she lost her Medicaid coverage (above), also appealed the loss of her Medicaid coverage and won, with Medicaid coverage restored back to the date that she lost it. Ms. Oh no longer owes past-due Medicare premiums. SSA refunded the amounts she paid under the installment plan. Ms. Oh does not have to pay installments going forward.
Practice Tip
In some cases, state Medicaid plans should restore help paying for Medicare premiums back to the date of application for that help, back to the date when the state should have screened for eligibility for that help, or even a number of months prior to the application.
How can an individual challenge an incorrect Medicare premium amount?
Medicare enrollees who receive an advance notice from SSA stating that they owe back Medicare premiums, and do not agree with the amount owed, can take action and file an appeal with SSA. First, Medicare enrollees can make an online request for non-medical reconsideration. Individuals can also complete the SSA-561 PDF form and fax it or send it via certified mail, with return receipt, to their local SSA office. They should keep proof of when the local SSA office received the appeal. Enrollees have 60 days from the date the advance notice was received to appeal. In some circumstances, there may be continued benefits pending appeal, including Goldberg Kelly Payment Continuation.[5]
Practice Tip
Sometimes, the continuation of Social Security payments at existing levels depends on quick appeal, for instance within 10 days of notice of adverse action. See SSA, Goldberg Kelly Payment Continuation.
Practice Tip
Some examples of incorrect Medicare premium amounts can include an incorrect calculation of the income-related adjustment (where there is a specific process if the person had a life-changing event), or an inaccurate application of a late enrollment penalty (See this Medicare Rights Center resource, How do I appeal my late enrollment penalty?, with more details on appealing a late enrollment penalty). SHIP counselors can help screen and advise on these issues.
Conclusion
For low-income older adults, back Medicare premiums can pose an unsustainable financial burden. The options for financial relief from retroactive premium liability offered by SSA provide a lifeline for older adults who rely primarily on their Social Security benefits to survive.
Advocates assisting low-income older adults impacted by Medicare back premiums can use this tip sheet to help their clients make a request for an installment plan, a hardship waiver, and/[6]or appeal with a request for non-medical reconsideration. Regardless of whether Medicare enrollees’ premiums are deducted from their Social Security benefit payment or billed, individuals can pursue any and all courses simultaneously.
Additional Resources
Installment Payment Plans
Waivers
Medicaid Appeals
SSA Appeals
Endnotes
Social Security Administration Program Operations Manual Systems (POMS) HI 00805.180, Payment of Premium Arrearage; Centers for Medicare and Medicaid Services, Helping Individuals When Medicaid Termination Results in Liability for Medicare Premiums ↑
Social Security Administration Program Operations Manual Systems (POMS) HI 00805.180, Payment of Premium Arrearage ↑
Centers for Medicare and Medicaid Services, Helping Individuals When Medicaid Termination Results in Liability for Medicare Premiums ↑
Centers for Medicare and Medicaid Services, Helping Individuals When Medicaid Termination Results in Liability for Medicare Premiums ↑
SSA POMS SI 02301.310 Appeal and the Right to Goldberg Kelly (GK) Payment Continuation ↑
