Issued by: Centers for Medicare & Medicaid Services (CMS)

Issue Date: November 14, 2014

Program Area: Distributed Data Collection (DDC) for RA Including HCRP/EDGE Server

Question: What do issuers do with partial premiums? If somebody is only enrolled for part of a month, issuers do not actually have a good way of getting partial premiums. Is an estimate acceptable or should the issuer put the full monthly premium and let the Centers for Medicare & Medicaid Services (CMS) prorate it?

Answer: For a partial month, issuers would have one (1) enrollment period that reflects the partial month. For example: The member is enrolled from the 15th through the 30th, that would be on one (1) line and then issuers would have another line where the full month began. When calculating the premium for the partial month, the issuer can choose to either put in a zero (0) (in some cases some issuers do not charge a premium for a partial month) or estimate the partial premium amount.

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