Centers for Medicare & Medicaid Services (CMS)

within 60 calendar days of the demand; interest is assessed from the date the demand letter was mailed^{1, 2}

within 12 months of the date of service³

Medicare coverage ends with the death, and no separate call to Medicare is needed to end it. Services furnished on the date of death are still covered, and the estate owes the normal cost-sharing on them.¹⁰

Medicare Advantage and Part D enrollment does not end on the date of death; disenrollment is effective the first day of the calendar month following the month of death. Prescriptions filled before the death remain covered, with the estate owing normal cost-sharing.^{8, 9}

CMS, not the family, notifies a Medicare Advantage or Part D plan of the death and disenrolls the member. A plan may stop premium bills once a death is reported to it, but may not disenroll the member until CMS systems show the death.¹¹

Medicare continues to process claims for covered services furnished before the beneficiary died. Providers submit them through normal Medicare billing; if a provider refuses or is unable to file, the estate can file Form CMS-1490S.³

The estate owes the deductible, copayment and coinsurance on covered services the person received. A provider who accepts assignment agrees "to charge you only the Medicare deductible and coinsurance amount"; a non-participating provider can charge more.¹²

A non-participating provider's charge in many cases can't be more than 15% above the Medicare-approved amount, the limiting charge. A provider who opted out of Medicare is outside both protections: Medicare pays nothing and the private contract governs.¹²

Where Medicare paid conditionally and a liability, no-fault or workers' compensation settlement follows, Medicare's claim "is properly asserted against the estate." A beneficiary's death "does not materially change Medicare's interest in recovering its payments."¹

For a Medicaid recipient age 55 or older, the state must seek recovery from the estate for nursing facility services, home and community-based services, and related hospital and prescription drug services. Recovery can reach real property, including the family home.¹³

Federal law bars Medicaid recovery from the estate of a recipient survived by a spouse, a child under 21, or a blind or disabled child of any age. Every state must have a procedure for waiving recovery that would cause undue hardship.¹⁴

A state may place a lien on the home during the lifetime of a permanently institutionalized Medicaid enrollee. The lien is barred while the spouse, a child under 21, a blind or disabled child, or a sibling with an equity interest lives in the home.¹³

Medicare takes no separate death report; the death is reported to Social Security. In most cases the funeral home reports it, so a family does not typically need to report the death itself.^{15, 16}

Medicare is called only about pending claims, billing or suspected misuse of the Medicare number. Medicaid is administered by the states, so the state Medicaid agency is contacted separately.¹⁵

Medicaid estate recovery rules, notices and claim deadlines are set by each state.¹³

The Medicare number must not be used for any service after the date of death, since coverage ended with the death. Medicare warns that medical identity theft happens when someone uses that information without consent; report suspected misuse to Medicare.¹⁷

For a Medicare Secondary Payer claim against the estate, CMS's contractor asks for a copy of the letters of administration and new proof of representation for the estate.¹

The death report for Medicare, and Medicare premium refunds claimed on Form SSA-1724^{16, 7}

Medicaid, including estate recovery rules, notices, claim deadlines and hardship waivers¹³

Suspected misuse of the Medicare number in a Medicare Advantage or Part D plan¹⁷