Section 233 of the Act prohibits the use of foreign coverage to establish entitlement
to free HI. Therefore, in most cases a retirement or survivor beneficiary who would
be eligible for free HI based on eligibility for regular RSI benefits will not be
eligible for free HI if insured status is met based only on the inclusion of foreign
periods of coverage.
Similarly, there is no free HI entitlement after 24 months of totalization disability
entitlement. Also, there is no premium HI eligibility for totalization disability
beneficiaries since a person must be 65 years old and entitled to SMI to qualify for
premium HI. See HI 00801.131 for a discussion of premium HI.
Many totalization beneficiaries can have HI coverage only if they meet the U.S. residence
and U.S. citizenship or lawfully admitted alien requirements which are contained in
If a worker becomes insured based on U.S. QCs only, free HI entitlement for the worker
and any auxiliaries begins:
at age 65 or the first month after age 65 that the worker is insured based on U.S.
QCs only for retirement benefits, or
at 24 months of entitlement to disability or the first month after 24 months that
the worker is insured based on U.S. QCs only.
SMI entitlement, if elected, begins during the IEP or the next GEP. See HI 00805.005 for specific details concerning the month of entitlement to SMI.