TN 4 (10-11)

A. Introduction to benefit waivers

1. Definition for waiver of benefits

Waiver of benefit payments is an administrative convenience to accommodate beneficiaries, who for personal reasons do not want payment, but find it advisable to remain entitled to benefits.

2. Reasons for waiver of benefits

Personal reasons can range from religious, patriotic, or political beliefs to situations where continued receipt of payments causes some adverse effect.

See Also

For information concerning application withdrawal, see GN 00206.001.

B. Field Office (FO) operating policy

1. Conditions for waiver

1. The waiver applies only to the requester's own payments; and

2. Waiver does not apply to a period for which benefits were paid unless full refund for the period is made; and

3. The full monthly benefit is being waived (see GN 02409.001C.1. if the beneficiary elected SMI); and

4. SSI is not involved.

2. Waiver on behalf of child or incapable adult by a representative payee

Develop waiver of benefits requests per GN 00504.260, and submit the requests to the Assistant Regional Commissioner (ARC), Management, and Operations Support (MOS), for a determination on approval of the request.

3. Withdrawal of a waiver

Withdrawal of the waiver must be in writing. The withdrawal is not retroactive, and will be effective only for the month of signing and subsequent months. For information on Revocation of Waiver Benefits, see GN 02409.030.

C. Related policy for waiving insurance premiums

1. Supplementary Medical Insurance (SMI) premium not waived

A beneficiary enrolled for SMI coverage may elect to waive all payments in excess of the SMI premiums. This action prevents termination for failure to pay premiums. For MACADE coding, see SM 00850.480.

2. SMI premium waived

A beneficiary may waive the entire benefit and pay premiums directly. The beneficiary must make this waiver request in writing to the FO.

3. Other deductions

A waiver can only apply to benefits that we pay to the beneficiary. When a beneficiary waives all payments except the SMI premium, we credit the Medicare trust fund with the amount of the premium payable each month, as if there were no waiver. If an event occurs that causes payment(s) for a prior month(s) not to be due, the beneficiary benefits because we paid the SMI premium(s) for that period. Since a waiver can only apply to monies that are due, the amount of the SMI premium paid is an overpayment, and the beneficiary must return it. For information on processing waiver of benefits, see GN 02409.020A.

4. Effect of waiver of benefits on Supplemental Security Income (SSI) eligibility

Waiver of benefits causes ineligibility for SSI in concurrent cases. For information on the requirement to file for other benefits, see SI 00510.001.