Payment Options for Individuals Who Owe Past-Due Medicare Premiums

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.

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.

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]

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]

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

1. 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 ↑

2. Social Security Administration Program Operations Manual Systems (POMS) HI 00805.180, Payment of Premium Arrearage ↑

3. Centers for Medicare and Medicaid Services, Helping Individuals When Medicaid Termination Results in Liability for Medicare Premiums ↑

4. Centers for Medicare and Medicaid Services, Helping Individuals When Medicaid Termination Results in Liability for Medicare Premiums ↑

5. SSA POMS SI 02301.310 Appeal and the Right to Goldberg Kelly (GK) Payment Continuation ↑