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Verifying Application for Medicare
SCD 169 - Refer to Apply for Medicare
The EW may use the “Referral to/from Social Security” (SCD 169) to verify application for Medicare or to refer aged/disabled US Citizens and LPRs who meet the 5 year residency requirement.
- The EW must clearly note the purpose of the referral by checking box III, “Application for Medicare.”
- The Social Security Administration will respond on the SCD 169 with Medicare eligibility information.
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Note: SPLTR 744 “Requirement to Apply for Medicare” should be sent along with the SCD 169.
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Timeframes
Verification of Medicare approval or denial must be submitted within 60 days of the date that the EW notifies the applicant/recipient of the requirement to apply. When application has been made, but eligibility for Medicare has not been determined within 60 days, the EW must:
- Verify that the client has actually applied for Medicare.
- Advise the customer that verification must be submitted within 10 days of the date the customer receives notification of Medicare eligibility or ineligibility.
Client Refusal
If the applicant/recipient refuses to apply for Medicare or refuses to provide verification of application, Medi-Cal benefits must be denied or discontinued.
Exception: Regulation only requires individuals to apply for other health coverage (including Medicare) when there is no cost involved to obtain it. If client has a SOC, they must not be discontinued for failure to apply for Medicare.
A recipient who is eligible for Medicare must not dis-enroll from Medicare once Medi-Cal eligibility is established.
Should this occur, Medi-Cal benefits must be denied or discontinued. Medi-Cal eligibility must not be restored until verification of reapplication for Medicare is submitted.
Verifications
Medicare eligibility must be verified by viewing any of the following:
- A Medicare card.
- A Social Security award letter showing the recipient’s MBI/HIC.
- An explanation of Medicare benefits form (BEOMB), issued by Medicare, showing Medicare payment for a medical bill.
- A bill for Medicare Part A or Part B.
- Other correspondence from the Social Security Administration which verifies Medicare eligibility.
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