TN 65 (01-24)

HI 00801.001 Introduction

A. Policy — General

The hospital insurance (HI) program (Part A of Medicare) provides payment for covered inpatient hospital, post-hospital extended care, and home health services. Participation in the HI program is limited to individuals who are:

  • Insured and age 65 or over (see HI 00801.006-.034)

  • Age 65 or over and meet the requirements of a special transitionally insured provision (see HI 00801.047-.121)

  • Uninsured and age 65 or over but elect to enroll and pay a monthly premium for HI coverage (see HI 00801.126-.145)

  • Disabled and entitled, or deemed entitled to, title II disability benefits for 24 months (see HI 00801.146-.163)

  • Disabled but working and eligible for HI only through payment of a monthly premium (see HI 00801.170-.174)

  • End-stage renal disease (ESRD) patients who are undergoing a course of renal dialysis or have received a kidney transplant (see HI 00801.186-.360)

  • Government employees (and auxiliaries and/or survivors of government employees) who would be insured for HI under the regular insured, disability or end-stage renal disease provisions if their government employment was social security covered employment (see HI 00801.400-.440)

B. Policy — Withdrawals

HI for insured individuals, including R-HI beneficiaries, can be annulled through withdrawal of the application (either monthly benefit or HI only) which resulted in the establishment of HI entitlement. As explained in GN 00206.020 any HI benefits paid between entitlement and withdrawal must be repaid before the withdrawal can become effective. Withdrawal from SMI and Premium-HI can only occur under the circumstances described in HI 00801.145, HI 00801.174 and HI 00805.080.

C. Policy — Effect of monthly benefit withdrawal on HI

An individual age 65 or over may withdraw an application for monthly RSI benefits without loss of HI. However, an individual under age 65 who withdraws an application for monthly disability benefits also loses HI and SMI. SMI terminates at the end of the month the individual is notified that the withdrawal has been approved.

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HI 00801.001 - Introduction - 01/09/2024
Batch run: 01/09/2024