TN 31 (06-04)

A. Introduction

Prior to 01/01/99, uninsured enrollees were only required to have SMI coverage when joining a Medicare Managed Care Plan (MMCP) with a Medicare contract. Thus, individuals who enrolled in an MMCP prior to 01/01/99, and do not have HI coverage because they are uninsured, may be offered hospital insurance coverage by the plan.

A contract with an MMCP can be terminated either by the plan or by Medicare. In addition, Medicare beneficiaries may voluntarily terminate their enrollment in an MMCP the month after they request such disenrollment. However, when enrollment in the MMCP ends, these individuals are left without the possibility of HI coverage for as many as 15 months, depending on the date of disenrollment.

B. Background

To alleviate the hardship that contract termination or voluntary disenrollment can cause uninsured individuals who are enrolled in an MMCP, as defined in HI 00208.066C.2. and D., the law was amended beginning 2/1/91, to provide an additional opportunity to enroll in Premium-HI and relief from the HI premium surcharge for late enrollment.

NOTE: This provision has absolutely no effect on SMI enrollment or SMI premium computation.

C. Policy

1. Who can enroll

The transfer enrollment period is for individuals age 65 or over, who meet the requirements in HI 00801.131 for entitlement to Premium-HI for the Aged.

NOTE: There is no requirement as to how long the individual must have been enrolled in a Medicare Managed Care Plan to qualify for the transfer enrollment period. In addition, enrollment in the MMCP need not be ending in order for the beneficiary to utilize the transfer enrollment period.

2. When can enrollment occur

An individual who meets the requirements in HI 00801.142C.1. may enroll:

• during any month in which the individual is enrolled in an MMCP, as defined in HI 00208.066C.2. and HI 00208.066D.; or

• during any of the 8 consecutive months following the last month during any part of which the individual was enrolled in the MMCP.

3. Transfer Enrollment Period and General Enrollment Period overlap

An individual who enrolls in a transfer enrollment period (TEP) month that occurs in January, February or March can elect to have the enrollment processed as either a GEP enrollment or as a TEP enrollment (see HI 00801.144).

If the individual chooses a GEP enrollment, coverage begins July 1. The premium surcharge is calculated using the months through the end of the GEP. However, all months of enrollment in an MMCP meeting the definition in HI 00208.066C.2. and HI 00208.066D. are subtracted from the calculation.

4. Coverage beginning date

If the individual enrolls in Premium-HI while still enrolled in an MMCP, or during the first full month when not enrolled in an MMCP, Premium-HI begins with either:

• the first day of the month of Premium-HI enrollment, or

• at the individual's option, with the first day of any of the following 3 months.

If the individual enrolls in Premium-HI during any of the remaining 7 months of this transfer enrollment period, Premium-HI coverage begins with the first day of the month after the month of Premium-HI enrollment.

5. Premium surcharge relief

The HI premium surcharge is determined by following the instructions in HI 01005.010. This means that all months after the end of the IEP through the end of the transfer enrollment period must be considered. However, in determining if there will be a Premium-HI surcharge and how long it will be payable, the following months are excluded.

• All months of enrollment in an MMCP meeting the definition in HI 00208.066C.2. and HI 00208.066.D., and

• Months in the remainder of the transfer enrollment period during which the individual is covered under Premium-HI.

Months of MMCP enrollment are excluded even if the individual is already enrolled in Premium-HI or is enrolling under GEP procedures.

6. Effective date

The transfer enrollment period provisions (including relief from a premium surcharge for months of MMCP enrollment) were effective beginning 2/1/91.

D. Examples

1. Enrollment in MMCP is ending

Jenny, who is uninsured, is entitled to SMI effective 6/96, the month she attained age 65. In 4/98, she enrolled in a Medicare Managed Care Plan. In 9/01, she is notified that the managed care plan is terminating its Medicare contract effective 12/31/01. If Jenny enrolls in Premium-HI at any time between 9/1/01 and 1/31/02, she can elect Premium-HI with the month of enrollment or any of the following 3 months.

If she enrolls between 2/1/02 and 8/31/02, she will have Premium-HI effective with the month after the month of enrollment.

2. Premium surcharge only

Will, who was age 65 in 4/95, did not enroll in SMI until 3/97. He was assessed a 10% premium surcharge when SMI became effective in 7/97. He also enrolled in an MMCP in 7/97. He terminated his MMCP enrollment effective with 12/31/98 and enrolled in Premium-HI during the 1999 GEP. His Premium-HI premium was increased by 10%, payable for 6 years because there were 44 months (3 full years) that elapsed between the end of his IEP and the GEP in which he enrolled (8/95 – 3/99).

In 6/00, he applied for a premium surcharge rollback because of his enrollment in the MMCP. His Premium-HI surcharge remains at 10 percent, but the period of time for which it is payable is reduced to 4 years. The 18 months from 7/97 through 12 /98, during which he was enrolled in an MMCP, were subtracted from the 44 months that elapsed after his IEP and through the end of the 1999 GEP, leaving 26 chargeable months (2 full years, instead of 3 full years).

3. No premium surcharge

Carl was entitled to SMI effective 12/96 when he attained age 65. He enrolled in an MMCP with coverage effective 4/97. The MMCP went out of business in 12/01, and Carl enrolled in Premium-HI in 6/02. Premium-HI entitlement begins 7/02. There is no penalty for late enrollment because the only months after the end of Carl’s IEP which are chargeable for premium surcharge purposes are the 6 months he was not covered by the MMCP (01/02 – 06/02).

4. Premium-HI enrollment while still in MMCP

Pam, who is uninsured, has been enrolled in SMI and an MMCP since 3/92, the month she attained age 65. Although she is still enrolled in the MMCP, Pam files for Premium-HI in 9/01, and based on her request, coverage begins 12/01.