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Fact Sheet: SSA Clarifies Handling of Medicare Part A Conditional Applications

August 7, 2018

Many people do not have enough work history to qualify for premium-free Medicare Part A benefits, however there is still an option for low-income individuals to get their Medicare Part A premiums paid.

A new Justice in Aging fact sheet details how they can enroll in the Qualified Medicare Beneficiary (QMB) Program to get their Medicare premiums paid through their state Medicaid program. Enrolling in QMB can be confusing for people without Part A coverage and often requires visits to both the Social Security Administration office and the stateā€™s Medicaid program offices. A further complication is that many Social Security offices have used conflicting and incorrect procedures or provided misinformation to applicants.

To address these problems, the Social Security Administration recently issued revised directions to its staff on how to handle conditional Medicare Part A applications from individuals planning to apply for Qualified Medicare Beneficiary program benefits with their state Medicaid agency. The revisions to the Program Operations Manual System (POMS) provide clarity on how SSA offices should handle conditional Part A applications and discuss how local Security Offices should handle state variations.

The revisions should go a long way to address inconsistencies that advocates have reported in SSA office procedures. Advocates can use the revised POMS to explain to their clients exactly what they should do to apply. Bringing copies of the POMS provisions with them to the SSA office will also ensure that SSA personnel use appropriate procedures.

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