A claimant age 65 or over had to be entitled to monthly Retirement or Survivors Insurance (RSI) benefits to qualify for HI benefits. Therefore, a claimant who withdrew their claim for monthly benefits lost HI entitlement and SMI if enrolled.

The P.L. 96-473 modified the Social Security Act to provide that we deem a claimant age 65 or over who filed a claim for monthly RSI benefits and HI, to have filed separate claims for cash benefits and HI coverage (see Section 226(a)(2)). In addition, we can deem the claimant entitled to HI based on the date of the original application for monthly benefits, which they subsequently withdrew. This applies only to claimants who are age 65 or over. It does not apply to Disability (i.e. DIB or disability freeze) claimants, Childhood disability beneficiaries (CDB), disabled surviving spouses, or disabled surviving divorced spouses.

Claimants age 65 and older who are entitled to both RSI and HI can withdraw the RSI benefit and retain HI.

If the claimant wants to withdraw the claim for monthly benefits and keep HI coverage, follow instructions to request only the RSI benefit refund in GN 00206.014. There is no need to repay any HI benefits already paid on the claimant's behalf since the claimant is not withdrawing the claim for HI coverage.

Claimants who withdraw an application for monthly disability benefits lose both HI and SMI benefits as the Medicare entitlement is based on the DIB award. If the claimant wants to withdraw the claim for DIB benefits and keep HI coverage, inform them that it is not possible and the WD of the DIB application will affect the Medicare entitlement. See HI 00820.001 Terminations and Withdrawals for detailed information about effect of withdrawal on HI.

If the claimant’s WD request includes withdrawing HI entitlement, the Field Office (FO) must follow instructions on GN 00206.014A. Once the Processing Center (PC) receives the WD request, the PC must contact the Center for Medicare and Medicaid Services (CMS) using the steps below before taking action on the WD request to determine whether they made HI payments on behalf of the claimant. The FO should not take a new claim until we receive verification from CMS and we approve the WD request.

Before approving the WD request, the PC must:

1. a. 

   Complete all entries on the top portion of a form SSA-L345 (Request for Verification of Hospital Insurance Payments).

2. b. 

   Use the email feature in the inform website to submit the request to CMS atL345east@cms.hhs.gov. The email must include the following information on the subject line:

   • •

     NH’s state of residence,

   • •

     NH’s name, and

   • •

     Beneficiary Medicare Number. For example: “Subject: NY-John Doe-B6” 1EG4–TE5–MK72

     IMPORTANT: Do not email the WD request or other associated material to CMS.

3. c. 

   Fax a copy of the SSA-L345 into the Non-Disability Repository for Evidentiary Documents (NDRed) and prepare a 15-day diary to follow up with CMS, if necessary.

4. d. 

   Send a follow up email request to CMS if you have not received a response when the 15-day diary matures. Write “Second request” in the subject line in addition the information included in the subject line on the initial request. Set another 15-day diary.

5. e. 

   Compute the claimant’s repayment amount using the response provided by CMS and add to the total repayment request as explained in GN 00206.014B.3.

The claimant has up to 45 days from the date of the notice to refund the benefits paid. Therefore, the PC must obtain a second verification for the HI to ensure CMS did not provide additional services. Follow the instructions below when the claimant submits the HI and cash benefits amounts needed for the WD request:

• •

  Call the CMS representative listed on the SSA-L345 completed by CMS to verify that no additional HI expenses occurred. Prepare a 15-day diary to follow up with CMS, if needed.

• •

  Document the file with the CMS confirmation (no new HI expenses were made) and process the WD request following GN 00206.014B.4.

If CMS informs you that additional HI payments are needed, complete and email a new SSA-L345 request following instructions in GN 00206.020D.2.