TN 31 (10-10)

DI 11015.020 Crediting Months of SSI/SSP toward the Disability Waiting Period and Medicare Qualifying Period for Disabled Widow(er)’s Benefits (DWB)

A. Explanation of provision under Public Law 101-508

In addition to making the definition of disability for DWB claimants the same as all other Title II adult disability claimants, Section 5103 of Public Law 101-508 provides that, for a disabled widow(er), each month in the period beginning with the first month of payment for Supplemental Security Income (SSI) or federally administered State Supplementary Payments (SSP), is counted toward both the 5-month waiting period for DWB entitlement and the 24-month Medicare qualifying period after December 1990.

Due to the prior SSI/SSP eligibility, a widow(er)’s new disability need not have continued through a separate, full 5-month waiting period before he or she may begin receiving DWB.

Reference:

DI 00115.015 – Definitions of Disability

NOTE: The first possible month of entitlement (MOE) to DWB benefits or to Medicare coverage based on crediting the SSI/SSP period, is January l991.

B. Applying the credit months

Count all months in the SSI/SSP period, beginning with the first month for which the individual received any payment and continuing through all succeeding months up to the DWB MOE (or deemed MOE for Medicare purposes only).

You may credit all months in the SSI/SSP period, whether or not the individual was in pay status. This includes months in which the individual:

  • was in SSI/SSP suspension status;

  • was in termination status; or

  • did not meet the nonmedical requirements for DWB entitlement during the period of SSI/SSP.

1. Review the Supplemental Security Record (SSR)

Identify the first month of payment in the computation history (CMPH) field of the SSR. For crediting purposes, it is the first instance when:

  • the payment status (PS) indicator is C01 or M01; and

  • an amount other than zero is displayed in the federal amount due (FAM) column.

2. Apply the SSI/SSP credit to determine the MOE to DWB

Due to the prior SSI/SSP eligibility, the waiting period effectively begins with the first C01 month displayed on the SSR. Begin crediting the waiting period by counting the first month of SSI/SSP eligibility and all subsequent months until you reach the requisite number of months (5 for DWB, 24 for Medicare). Once SSI/SSP months are credited, the earliest possible MOE to Medicare is the beneficiary’s month of entitlement to disability benefits.

If the onset is August 1, 1990 or earlier, or if no waiting period is required, see DI 11015.020B.3. in this section.

Reference:

  • DI 10105.070 – Waiting Period for Disability Insurance Benefits (DIB)

NOTE: Do not establish the MOE under this provision before other requirements for DWB are also met, e.g., DWB attainment of age 50, death of the wage earner, 12-month retroactivity of application.

3. Determine the Medicare effective date

Determine the effective date for Medicare coverage by crediting the SSI/SSP period toward the 24-month qualifying period for months after December 1990. The earliest possible MOE to Medicare is the beneficiary’s month of entitlement to disability benefits.

NOTE: 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.

References:

  • HI 00801.154 – SSI/SSP Credit for Disabled Widow(er)s

  • HI 00801.155 – Deemed Entitlement to DWB for Medicare

  • SM 03040.030 – Equitable Relief on an Initial Award Processed by MCS

4. Record the MOE and waiting period data

  • Record the information used in the MOE and waiting period determination on a report of contact (RPOC) in the Modernized Claims System (MCS).

  • Input the Medicare entitlement information on the Health Insurance-Supp Medical Insurance (HICL) screen in MCS.

See Details:

MSOM MCS 009.007 – Health Insurance-Supp Medical Insurance (HICL)

C. Example calculations of MOE and Medicare effective date for DWB claims using SSI/SSP credit months

1. Example 1

A disabled widow protectively files an application for DWB in 08/2009.

While reviewing queries during your pre-claim development, it becomes apparent that she had received SSI from 09/2007 until 02/2008, at which time her eligibility ceased due to excess resources. Although this SSI record has terminated, you know to count all the months in the period until the month prior to DWB entitlement and to apply that credit to her DWB waiting period, should she be found disabled.

After the DDS review, the onset is established as of 06/13/2008, the date of a new disability.

Follow the steps as outlined above and proceed as follows:

  1. From reviewing the CMPH field of the SSR, 09/2007 is the first C01 month with a dollar amount other than zero. The crediting period begins here.

  2. Apply the SSI/SSP credit months beginning 09/2007. The “effective” waiting period is 09/2007 through 01/2008.

    • Since the MOE is restricted by the limits of retroactivity due to the protected filing date, the widow has already served her five-month waiting period prior to the retroactive scope of the application.

    • MOE: 08/2008

  3. Apply the SSI/SSP credit months beginning 09/2007 to the 24-month Medicare qualifying period. Her Medicare effective date is:

    • 09/2007 plus 24 months = 09/2009

  4. Record the information on the appropriate MCS screens.

2. Example 2

A disabled widow protectively files an application for DWB in 07/2007.

She received SSI from 02/2001 until 12/2003 when her benefits terminated due to excess income.

After the DDS review, the onset is established as of 01/03/2007, the date of a new disability.

Follow the steps as outlined above and proceed as follows:

  1. From reviewing the CMPH field of the SSR, 02/2001 is the first C01 month with a dollar amount other than zero. The crediting period begins here.

  2. Apply the SSI/SSP credit months beginning 02/2001. The “effective” waiting period is 02/2001 through 06/2001.

    • MOE: 01/2007

  3. Apply the SSI/SSP credit months beginning 02/2001 to the 24-month Medicare qualifying period. Her Medicare effective date is:

    • 01/2007

    • Although there are 76 elapsed months creditable due to the SSI/SSP period, retroactivity is limited by the protected filing date and established onset date of 01/03/2007.

  4. Record the information on the appropriate MCS screens.

NOTE: In this example, there is no requirement that the widow be under a disability “throughout” the full month. The law provides that entitlement to widow(er)’s benefits based on a disability begins with the first month after the waiting period in which he or she becomes so entitled. Under the special rule enacted by section 5103 of Public Law No. 101-508, the widow in this example had already served her waiting period by 07/2001. Assuming the other factors of entitlement are met (i.e., age, relationship, established onset prior to the end of the prescribed period), she became entitled to benefits for January 2007, the first month “in which” she was disabled.

3. Example 3

A disabled widow protectively files an application for DWB in 01/1991.

Prior to sending the case to the DDS, your thorough review of her record indicates that she received SSI/SSP payments beginning in 01/1988. Although her SSI had since terminated, you know to count all months in the period until the month prior to DWB entitlement and apply that credit to her waiting period, should she be found disabled.

After DDS’s review, the onset is established as of 10/04/1990, the date of a new disability.

Follow the steps as outlined above and proceed as follows:

  1. From reviewing the CMPH field of the SSR, 01/1988 is the first C01 month with a dollar amount other than zero. The crediting period begins here.

  2. Apply her SSI/SSP credit months beginning 01/1988.

    • Since the first possible month of entitlement under this provision is 01/1991, the MOE is 01/1991.

  3. Apply the SSI/SSP credit months beginning 01/1988 to the 24-month Medicare qualifying period. Despite having more than 24 creditable months, her Medicare effective date is limited by Section 5103 of Public Law 101-508 to 01/1991.

  4. Record the information on the appropriate MCS screens.

4. Example 4

A disabled widow protectively files an application for DWB in 01/1991.

After DDS’s review, onset is established as of 06/01/1989 based on the adoption of a Title XVI medical/vocational allowance. The MOE can be no earlier than 01/1991, the effective date of Section 5103, because the DDS has entered “MOE restricted to 01/91 - P.L. 101-508” in the remarks section of the SSA-831. For additional information concerning the disability standard for DWB purposes prior to the effective date of P.L. 101-508, see Definitions of Disability DI 00115.015A.

Proceed as follows:

  1. From reviewing the CMPH field of the SSR, 06/1989 is the first C01 month with a dollar amount other than zero. The crediting period begins here.

  2. Apply her SSI/SSP credit months beginning 06/1989.

    • MOE: 01/1991 (MOE cannot be before 01/1991 - SSI/SSP months have no effect.)

  3. Apply the SSI/SSP credit months beginning 06/1989 to the 24-month Medicare qualifying period. Her Medicare effective date is:

    • 06/1989 plus 24 months = 06/1991.

  4. Record the information on the appropriate MCS screens.

5. Example 5

An SSI recipient, with an established onset date of 06/01/1990, becomes entitled to disability insurance benefits (DIB) based on his date first insured of 04/1991.

His wife passed away in 01/1992.

During an SSI redetermination, he files a DWB application in 01/1993. Based on the adoption of the Title XVI determination, onset for DWB is established as 06/01/1990.

Since he did not file until 01/1993, the DWB MOE is restricted by the date of death to 01/1992 (12 months retroactivity). Before this provision, considering only the DWB entitlement, Medicare would be effective 01/1994, based on a 24-month qualifying period.

Proceed as follows:

  1. From reviewing the CMPH field of the SSR, 06/1990 is the first C01 month with a dollar amount other than zero. The crediting period begins here.

  2. Apply his SSI/SSP credit months beginning 06/1990.

  3. Considering his DWB entitlement only, the regular Medicare effective date is 01/1994 after serving the 24-month qualifying period. However, after crediting SSI/SSP months to the qualifying period, the Medicare effective date becomes:

    • 06/1990 plus 24 months = 06/1992.

  4. Record the information on the appropriate MCS screens.

NOTE: In this example, note the difference in Medicare effective dates because of the SSI credit months:

  • Effective date for Medicare after SSI credit months: 06/1992.

  • Effective date for Medicare due to DIB: 09/1993.

Due to the DWB entitlement, the claimant will be entitled to Medicare fifteen months earlier than he otherwise would have been based solely on his DIB entitlement.


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