Last Modified: 6/24/2020
Location: FL, PR, USVI
Business: Part A, Part B
Q: If the eligibility page on the SPOT displays the “Inactive Period” section, what does it mean? Has the beneficiary’s Part A and/or Part B eligibility been terminated?
A: If the SPOT returns data in the Inactive Periods section, it means that although the beneficiary is entitled to Medicare, he or she is ineligible for Medicare benefits over a period of time for one or more of the following reasons:
• The Medicare beneficiary has been classified as an illegal alien in the United States.
• The Medicare beneficiary has been deported from the United States.
• The Medicare beneficiary has been incarcerated.
Note: Information specifying the reason for the period of ineligibility will not be released by HIPAA Eligibility Transaction System (HETS), which is the source for all eligibility data accessed through the SPOT.
Note: If an inactive period is returned but a termination date for either Part A or Part B eligibility is not, it means that the Social Security Administration (SSA) still considers the beneficiary to be entitled to Medicare. However, during the specified inactive period, services furnished to that beneficiary will not be covered.
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