Determinations as to whether an individual meets the requirements for entitlement to Medicare Part A (Hospital Insurance, HI); e.g., age, entitlement to monthly benefits,
application requirements, insured status, and for enrollment under Medicare Part B (Supplementary Medical Insurance, SMI) are for purposes of
these instructions considered “entitlement” determinations.
Any individual who is dissatisfied with an initial determination of health insurance
entitlement (Part A or B) has the same appeal rights and may follow the same appeal
procedures as in a claim under title II of the Act (see GN 03101.001). A beneficiary may request a reconsideration, hearing before an Administrative Law
Judge (ALJ), Medicare Appeals Council (MAC) review, and ultimately, seek judicial
relief if he or she remains dissatisfied with the determination.