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TWWIIA Extended Medicare Coverage Decision Tree

To apply this new policy, practitioners can follow the decision tree below and/or simply use the Medicare Wizard Online to determine the Medicare ending date.

Did SGA occur prior to the 14th month of EPE after the TWP? - YES - Did the individual perform SGA in the 16th month? - YES - Begin counting 57 months off starting the month after the 36th month of the EPE to determine when the person's Medicare ends. Or if later, the date of the benefit termination notice plus one month.

Did SGA occur prior to the 14th month of EPE after the TWP? - YES - Did the individual perform SGA in the 16th month? - NO - Did SGA occur after the 16th month of the EPE? - YES - Start counting 77 months beginning with the month following the first month of SGA after the 16th month to determine when the person's Medicare ends. Or if later, the date of the benefit termination notice plus one month.

Did SGA occur prior to the 14th month of EPE after the TWP? - NO - Did SGA occur after the 13th month of the EPE? - YES - Start counting 80 months beginning with the month following the first month of SGA after the TWP to determine when the person's Medicare ends. Or if later, the date of the benefit termination notice plus one month.

NOTE: In all three cases, Medicare would end the last day of the month as specified above and terminate the first of the following month.



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