TN 9 (10-93)

RS 00208.110 Medicare - Requirements for Entitlement - Mothers/Fathers

A. Background

1. 1972 Amendments

Hospital insurance (HI) under Part A of Medicare was extended to an individual entitled as a disabled widow for 24 consecutive months beginning 7/77. Individuals so entitled are also eligible for supplementary medical insurance (SMI) under Part B of Medicare.

Under this coverage provision a mother beneficiary may become entitled to HI and SMI after 24 months of deemed entitlement to DWB.

2. 1980 Amendments

Effective for months after 11/80 months of deemed or actual entitlement to DWB did not have to be consecutive.

3. 1983 Amendments

A disabled father beneficiary could also be deemed to be entitled as a DWB for HI purposes only, but could not be entitled to HI until 5/83. A father beneficiary who meets the requirements may be deemed to be entitled as a DWB for up to 24 months prior to 5/83, but his first MOET to HI can be no earlier than 5/83.

B. Policy

A disabled individual between ages 50-65 who is entitled to mother's or father's insurance benefits and who files for HI is deemed, for HI purposes only, to have filed as a disabled widow(er) upon furnishing proof of disability and meeting all other requirements for eligibility to DWB (follow RS 00207.007 ff.). He or she is deemed to have been entitled to these benefits, for HI purposes only beginning with the first month for which he or she could have been entitled based on deemed filing as a disabled widow(er).

Entitlement to Medicare begins with the 25th month of deemed, actual or deemed plus actual DWB entitlement.

EXCEPTION: Effective July 1, 2001, a disability beneficiary diagnosed with Amyotrophic Lateral Sclerosis (ALS), better known as Lou Gehring’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)

Unless declined, entitlement to SMI begins the same month as HI. (See HI 00801.146 ff. for discussion.)

“Child-in-care” deductions apply for any month in which a child is not in care. If the claimant wishes to become actually entitled as a DWB, he/she must file an SSA-10-BK indicating the first month within the retroactive life of the application, entitlement is to begin. Usually this will be the first month in which the child is not in care. Failure to file the SSA-10-BK will not affect Medicare entitlement. Since the widow(er)'s disability and other factors of entitlement will already have been established, no additional proofs will be needed.


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http://policy.ssa.gov/poms.nsf/lnx/0300208110