a) If a person files the application establishing entitlement to HI in the last 4
months of the IEP or during a GEP, the person is deemed to have enrolled for SMI at
the time the HI application is filed.
If the application establishing entitlement to HI is filed after the IEP, but during
the GEP , the individual is deemed to have filed the enrollment request on the first
day of the current GEP.
b) These individuals will be deemed to have filed in January and the SMI start date
will be February.
Example 1 (After 1/1/2023): Bobby Smith attained age 65 in 1/2022 but did not file for monthly benefits and Medicare.
In 3/2023, Bobby filed for and was awarded monthly retirement benefits and HI. Bobby
did not refuse SMI. Because filing occurred after Bobby's IEP, but during a GEP, Bobby
is deemed to have enrolled in SMI on the first day of the current GEP (1/1/2023).
Bobby will have SMI coverage beginning 02/1/2023.
Example 2 (After 1/1/2023): If Jane Doe files 1/1/2023 – 03/31/2023 the GEP SMI-START = 02/2023 since we are
deeming the filing date to be 01/2023.
Example 3 (After 1/1/2023): If John Doe files 1/1/2024 – 03/31/2024 the GEP SMI-START = 02/2024 since we are
deeming the filing date to be 01/2024.
And so on, for any Initial Establishment and SMI-Filing occurring in January-March
where the beneficiary is not in an IEP or SEP, the SMI-START is effective February
of that same year since we are deeming the filing date to be January of that year.
c) If the application establishing entitlement to HI is filed after the IEP, but not
during a GEP or SEP, the individual is deemed to have filed the enrollment request
on the first day of the next GEP.
Example 4 (Before 1/1/2023): Mary Hanover did not file for monthly benefits and Medicare when Mary attained age
65 in 9/90. In 11/91, Mary filed and was awarded monthly benefits and HI. Mary did
not refuse SMI. Because filing occurred after Mary's IEP, but not during a GEP, Mary
is deemed to have enrolled in SMI on the first day of the next GEP (1/01/92) with
coverage beginning 7/1/92.
Example 5 (After 1/1/2023): Maggie Winston did not file for monthly benefits and Medicare when Maggie attained
age 65 in 5/23. In 7/24, Maggie filed and was awarded monthly benefits and HI. Maggie
did not refuse SMI. Because filing occurred after Maggie's IEP, but not during a GEP,
Maggie is deemed to have enrolled in SMI on the first day of the next GEP (1/01/25)
with coverage beginning 2/1/25.