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ESRD Medicare - Cancellation

ESRD Medicare - Cancellation - Patient Resources, Social Work Services Quick Guide, Social Work Manual, Population Specific, Transplant, Kidney Transplant, Financial


1. Application May Be Withdrawn

An ESRD application may be withdrawn at any time after it is filed, even if entitlement has begun. Any Part A benefits paid to, or on behalf of, the claimant must be repaid to the Medicare program before the withdrawal is approved. The form SSA-L345 (Verification of Hospital Insurance Payments) should be completed and sent to CMS (see GN 00206.095 B.1.c. for instructions).

However, where the withdrawal and refiling are occurring at the same time and the beneficiary elects R-HI to begin again with the first month for which Part A benefits were paid, there would be no overpayment of benefits and no need for repayment. See HI 00801.197B.2. for an example of this situation.

2. Reason for Withdrawing

Usually (but not exclusively), withdrawal of R-HI occurs when Medicare is the secondary payer of benefits (see HI 00801.247 for a discussion of the circumstances under which Medicare is the secondary payer for R-HI beneficiaries) and the individual discovers after R-HI and R-SMI have gone into effect that the employer plan will pay all expenses. Withdrawal of the R-HI application terminates R-SMI.

Whether or not R-SMI was elected on the original application for R-HI, on refiling for R-HI, as explained in HI 00801.197.A.5., a new initial enrollment period (IEP) for R-SMI occurs. This means that, upon reenrollment in Medicare, the enrollee will not have wait for a GEP to enroll for SMI and there will be no premium surcharge for late enrollment.