The 1972 amendments extended HI coverage, both Part A, Hospital Benefits, and Part
B, Medical Benefits, to disability beneficiaries, including disabled widow(er)s (DWBs).
(See policy in HI 00801.146, Entitlement to HI for the Disabled.)
A claimant who has been entitled to DWB for 24 months and is currently entitled will
automatically be entitled to health insurance (HI) beginning with the 25th month of
entitlement (MOET) (but not before 7/1973). For credit of months of Social Security
Insurance (SSI) payment and/or State Supplementary Payment (SSP) for payments after
12/1990, see DI 11015.020 and HI 00801.154.
In counting the 24-month period, certain months in which a claimant was not actually
entitled as a DWB will be included if he or she can be deemed to have been entitled
as a DWB for HI purposes only as explained below.
Entitlement to supplementary medical insurance (SMI) would begin effective the same
month as HI, unless the claimant declines the former. (See HI 00805.005, Eligibility for SMI.) When retroactive SMI is involved, follow existing equitable
relief procedures in Enrollment Not Processed Timely, HI 00805.195 and in Granting Equitable Relief, HI 00830.001.
EXCEPTION: Effective July 1, 2001, a disability beneficiary diagnosed with Amyotrophic Lateral
Sclerosis (ALS), better known as Lou Gehrig’s disease, will not have to serve the
24-month Medicare waiting period. The date of entitlement to Medicare is the date
of entitlement to disability (DOED) benefits or July 1, 2001, whichever is later.
The Diagnosis code (either primary (DIG) or secondary (SDIG)) will be 3350. (See DI 45605.001, Amyotrophic Lateral Sclerosis (ALS) – Medicare Waiting Period Waived – Processing
Center (PC) and DI 11036.001, Amyotrophic Lateral Sclerosis (ALS) – Medicare Waiting Period Waived – Field Office