Effective Dates: 11/21/2022 - Present Previous | Next

TN 63 (11-22)

HI 00805.085 Effect of Reentitlement to HI After Termination

A. Policy

1. New IEP if reentitled to D-HI or R-HI

During each separate period of HI entitlement, SMI enrollment rights and premium rates are determined independently of enrollments during any previous periods of HI entitlement. Where a person's D-HI or R-HI terminates and the person later becomes reentitled to D-HI or R-HI, for purposes of SMI enrollment and premium amounts, the person is deemed to have never had previous eligibility.

This means the individual has a new IEP, beginning 3 months before the first month of the new period of HI entitlement.

NOTE: Disability beneficiaries do not always have a 24–month waiting period if they become reentitled to disability benefits. (See HI 00801.152.)

2. New IEP for age 65 HI

Even if previously entitled to HI as a disability beneficiary or ESRD patient, a person who becomes entitled to HI under the regular or deemed insured provisions at age 65, has an new IEP. SMI enrollment rights (and premium amounts) are not affected by any events which occurred during previous periods of HI entitlement.

If the person previously refused SMI, the person has a new IEP based on the new period of HI eligibility and may enroll for SMI.

If an increased premium was payable for late enrollment prior to age 65, the premium is reduced to the standard rate for the month of attainment of age 65 and following months of continuous coverage (see HI 01001.010B.3.).

Those who had one or more earlier periods of HI entitlement are not penalized for events which took place during such earlier periods.

NOTE: These provisions ensure that all persons upon becoming entitled to HI (at age 65 or otherwise) will be treated identically.

B. Example

Carol Dibb, born 9/10/30, established entitlement to D-HI beginning 5/84 but refused SMI enrollment at that time.

Upon attaining age 65 in 9/95, Carol becomes eligible for HI under the regular insured provision. (As explained in HI 00820.025A., HI and SMI based on entitlement to disability benefits technically terminates with the month before the month of attainment of age 65.)

Carol Dibb has a new IEP based on Carol's new period of HI eligibility and will be automatically enrolled for SMI as of 9/95.

(If Carol Dibb had enrolled for D-SMI in a GEP and was paying an increased premium for late enrollment in the month prior to attaining age 65, Carol's premium rate will be reduced to the standard rate beginning at age 65.)

To Link to this section - Use this URL:
http://policy.ssa.gov/poms.nsf/lnx/0600805085
HI 00805.085 - Effect of Reentitlement to HI After Termination - 11/21/2022
Batch run: 11/21/2022
Rev:11/21/2022