TennCare Approved but Still Paying Medicare Premium: Why and What to Do

Your parent's TennCare approval letter arrived. The notice says QMB or SLMB, effective next month. But their Social Security statement still shows $202.90 deducted for the Part B premium — the same deduction the program was supposed to eliminate. Nothing looks like it's working.

This is almost certainly the buy-in processing lag, not a denial or an error. It happens to nearly everyone, and TennCare's approval notice doesn't explain it.

What's Actually Happening

When TennCare approves a Medicare Savings Program application, it sends a buy-in record to the Centers for Medicare & Medicaid Services (CMS). CMS updates its master file and instructs the Social Security Administration to stop deducting the Part B premium from your parent's monthly check.

That three-agency chain — TennCare to CMS to SSA — typically takes 60 to 90 days to complete. During that window, Social Security continues deducting $202.90 as though nothing changed. Your parent's approval is real; the payment system just hasn't caught up yet.

The Refund

Social Security does not simply stop the deduction and move on. Once the buy-in update hits their system, SSA:

1. Stops withholding the Part B premium going forward
2. Issues a lump-sum refund for every month the premium was deducted after coverage began

If QMB was approved in February with a March 1 effective date, and SSA processes the update in May, your parent could receive a lump-sum refund for March through May — about $608.70 if premiums were withheld in all three months — by direct deposit or as an adjustment to a future Social Security payment.

SLMB and QI enrollees may see retroactive coverage up to three months before the application date, which means the refund could be even larger.

When to Worry

The buy-in lag is normal for the first 60 to 90 days after approval. Beyond that window, something may have gone wrong in the data transmission. At that point:

• Call TennCare Connect at 1-855-259-0701 and confirm that the buy-in record was transmitted to CMS. Ask for the date it was sent.
• Call Social Security at 1-800-772-1213 and ask whether they've received the state buy-in file for your parent. Reference the TennCare case number.
• If either agency shows a gap, the issue is usually a data mismatch — a name, SSN, or Medicare number discrepancy between TennCare's record and SSA's. This can be corrected with a phone call to TennCare to reconcile the record.

Don't Assume It Failed

The most common mistake families make during this window is assuming the application was lost or denied and submitting a second application. A duplicate application doesn't speed anything up — it creates a new case that competes with the first one in the system.

Keep the approval notice. It's your proof that coverage is in effect even while the premium deduction continues. If a provider tries to bill your parent for Medicare cost-sharing during this period and they have QMB, the approval notice plus their Medicare card is enough to invoke balance-billing protection.

Tracking the Timeline

The Tennessee Medicare Savings Programs & Extra Help Guide includes a premium tracking worksheet and a step-by-step escalation process for when the refund takes longer than expected. It also covers the Social Security Fairness Act impact — if your parent received a retroactive lump-sum from the WEP/GPO repeal, that payment is excluded from resources for nine months, but the new higher monthly benefit does count as income at the next renewal.

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