Effective Dates: 12/05/2022 - Present Previous | Next

TN 66 (12-22)

HI 00805.165 Individual Enrollment - When A Coverage Period Begins

A. Policy - General

The beginning of an individual's SMI coverage period depends on the enrollment period and the month in which the individual enrolls, or is deemed enrolled.

B. Policy - IEP enrollment

1. Rules on January 1, 2023 and after

For an individual who first meets the eligibility requirements of HI 00805.005 and enrolls in the IEP January 1, 2023 or after (see HI 00805.015), the beginning of the SMI coverage period is related to the month of enrollment, as follows:

a. Before first month of eligibility

If an individual enrolls in the 3 months prior to the first month of eligibility for SMI, the coverage period will begin on the first day of the month of eligibility.

b. In first month of eligibility or in the last 3 months following the month of first eligibility

If an individual enrolls in the first month of eligibility or in the last 3 months following the month of first eligibility, the coverage period begins with the first day of the next month.

EXAMPLE: If a person first meets the requirements in June and enrolls in July, the coverage period begins the first day of August.

2. Rules before January 1, 2023 - Historical Information

For an individual who first meets the eligibility requirements of HI 00805.005 on or after 3/1/66 and enrolled during the IEP before or on 12/31/22 (see HI 00805.015), the beginning of the SMI coverage period is related to the month of enrollment, as follows:

a. Before first month of eligibility

If an individual enrolls in the 3 months prior to the first month of eligibility for SMI, the coverage period will begin on the first day of the month of eligibility.

b. In first month of eligibility

If an individual enrolls in the first month of eligibility, the coverage period begins with the first day of the next month.

c. In the month following the month of first eligibility

If an individual enrolls in the month following the first month of eligibility, the coverage period begins with the first day of the second month following the month in which the individual enrolls.

EXAMPLE: If a person first meets the requirements in June and enrolls in July, the coverage period begins the first day of September.

d. In last 2 months of the IEP

If an individual enrolls in the last two months of the IEP, the coverage period begins the first day of the third month following the month of enrollment.

EXAMPLE: If a person first meets the requirements in June and enrolls in August, the coverage period begins the first day of November. If enrollment is in September, the coverage period begins on the first day of December.

e. Overriding rules

No coverage could begin before 7/1/66. All persons eligible before 6/66 and enrolling before 6/66, had SMI coverage beginning 7/1/66.

C. Description of IEP enrollment

1. Rules on January 1, 2023 and after

The following chart (valid for persons who enroll after January 1, 2023) illustrates the situations in B.1, above.

EXAMPLE: An individual’s 65th birthday is April 10 and they first meet the eligibility requirements for enrollment on April 1:

Enrolls in IEP:

Entitlement begins on—

January

April 1 (month eligibility requirements first met)

February

April 1

March

April 1

April

May 1 (month following month of enrollment)

May

June 1 (month following month of enrollment)

June

July 1 (month following month of enrollment)

July

August 1 (month following month of enrollment)

2. Rules before January 1, 2023 - Historical Information

The following chart (valid for persons first eligible after June 1966) illustrates the situations in B.2, above.

This Chart Illustrates the Initial Enrollment Period

D. Policy - GEP enrollment

If an individual enrolls or re-enrolls during a GEP (January through March), but after the IEP, the SMI coverage period begins the first of the month following the month of enrollment.

Prior to January 1, 2023, SMI entitlement based on a GEP enrollment always began July 1 of the year during which the GEP enrollment took place.

E. Policy - Equitable relief

Because of the problems caused by retroactive SMI entitlement, in many equitable relief cases (see HI 00805.170), an individual's SMI entitlement may begin with the month in which the SMI award is processed rather than a much earlier date based on the time of enrollment.

F. References

  • •

    HI 00805.045 Deemed Enrollment – R-HI Beneficiaries

  • •

    HI 00805.275 Special Enrollment Period (SEP) Enrollments

To Link to this section - Use this URL:
http://policy.ssa.gov/poms.nsf/lnx/0600805165
HI 00805.165 - Individual Enrollment - When A Coverage Period Begins - 12/05/2022
Batch run: 10/10/2024
Rev:12/05/2022