The Social Security Act governs whether an individual meets the requirements of relationship. Accordingly, a survivor who has been awarded monthly social security or railroad retirement benefits as the spouse, child, or parent of the deceased will be deemed to have this status for Medicare purposes.

When a claimant's allegation of relationship is challenged by evidence to the contrary, the DO should apply the definitions of relationship which are briefly outlined in the following sections. If documentation is necessary, follow the instructions for development in the appropriate POMS section.

The DO should bear in mind that each degree of relationship—spouse, child, parent—appears twice in the priority listing in GN 02335.025 A.2. Therefore, the individual who meets the definition may be either high or low on the list. The factor (aside from the relationship to the deceased) which controls the individual's position in the priorities in most instances is whether or not the individual was entitled to monthly benefits on the same earnings record as the deceased beneficiary.

The phrase “on the same earnings record” does not necessarily mean the earnings record of the beneficiary. A female beneficiary may not have had an earnings record, but have been entitled to monthly benefits on the spouse's earnings record. Thus, both parties are entitled on the same earnings record and the spouse will qualify in priority number 1 (GN 02335.025 A.2.) above.

Aside from the question of entitlement to monthly benefits, a person who was living with the deceased as a spouse in the month of the spouse's death will be presumed to be the spouse of the deceased in the absence of clear and strong evidence to the contrary.

A person who was living with the beneficiary will qualify as a surviving spouse in priority number 1 (GN 02335.025 A.2.), if the individual:

1. a. 

   Was validly married to the beneficiary at the time of death (GN 00305.035).

2. b. 

   Would be considered to have the status of the living spouse of the deceased with respect to the taking of intestate personal property by the courts of the State in which the deceased lived at the time of death; or

3. c. 

   Married the beneficiary in good faith but the marriage was invalid because of a legal impediment not known to the claimant at the time of the marriage provided the claimant was living in the same household with the beneficiary at the time of the beneficiary's death (GN 00305.170).

A couple will be considered to be living together as spouses in the month of the beneficiary's death even though they were actually separated at the time of death if their separation was caused solely by the illness of either, or by other circumstances beyond their control. If the spouse was not living in the same household with the beneficiary at the time of death, record on a report of contact the length of, and the reason(s) for, the separation. If the separation lasted more than 6 months, sufficient information should be obtained about the circumstances to permit a determination as to whether there was an intent to resume living together in the same household. If such intent can reasonably be found, payment may be made to the surviving spouse. For complete instructions on living in the same household see RS 00210.020.

An individual who was neither living in the same household with the decedent at the time the decendent died, nor entitled to monthly benefits on the same earnings record will qualify as a surviving spouse in priority number 4 if the individual otherwise meets the relationship requirements.