TN 1 (04-09)

DI 11040.001 Deemed Medicare Cases

A. Medicare qualifications for a mother, father, or widow(er)

To qualify for Medicare, a mother, father, or widow(er) must establish that he or she meets all the requirements for Disabled Widow(er)’s Benefits (DWB). Therefore, a mother, father, or widow(er) seeking Medicare based on deemed DWB entitlement must submit proof of age (POA) and evidence of disability. The claimant must be found disabled before the end of the prescribed period. The disability must begin at least 5 full calendar months before the month in which the widow(er) attains age 60 (before age 62 years and 7 months if disability is being established for “Medicare only” purposes) and no later than 84 months after the latest of the following months:

  • The month of the Number Holder’s (NH) death;

  • The month in which previous entitlement to disabled widow(er) benefits (DWB) terminated because the disability had ceased;

  • For a widow(er) or surviving divorced spouse, the last month of entitlement to mother's or father's benefits based on the NH’s record.

A disability which began before the worker died or while the claimant was entitled to mother’s or father’s insurance benefits, based on the worker’s record meets the above requirements.

See also:

  • DI 10135.001 - Deemed Entitlement to DWB for Medicare – General

  • DI 11015.001 - Disabled Widow(er)’s Benefits – General

  • DI 25501.360 - Established Onset in Deemed Entitlement to Disabled Widow(er)’s Benefits for Medicare Claims

  • RS 00208.110 - Medicare-Requirements for Entitlement-Mothers/Fathers

  • RS 00208.115 - Medicare-Development and Forwarding of Claims-Mothers/Fathers

  • HI 00801.155 - Deemed Entitlement to DWB for Medicare

  • DI 81010.025 – Completing Electronic Disability Collect System (EDCS) Forms for Initial Claims

B. Onset dates

Many disabled widow(er) cases involve onset dates long past; however, establishing a precise date of onset will not be necessary for all cases. For example, if the evidence establishes that the individual was disabled more than 5 full months prior to the beginning of the prescribed period, that determination would eliminate the need to establish the precise month, day, or year of onset.

See also:

  • DI 11005.050 - Prescribed Period and Controlling Date

  • DI 11015.001 - Disabled Widow(er)’s Benefits – General

  • DI 25501.350 - Establishing an Established Onset Date (EOD) for Disabled Widow(er) (DWB) Cases (Not Medicare)

  • DI 25501.360 - Established Onset in Deemed Entitlement to Disabled Widow(er)’s Benefits for Medicare Claims

C. Development and transmitting of claims

For information on the development of DWB cases, see RS 00208.115 - Medicare - Development and Forwarding of Claims - Mothers/Fathers

For information on folder preparation for transmittal of DWB cases, see:

D. Special situations for subsequent claims for mother, father, or widow(er)

1. Mother beneficiary under age 50 filing for disability determination for Medicare purposes or widow(er) beneficiary age 60-64 alleging disability after the prescribed period ends

The Field Office (FO) will make a determination of disallowance and notify the claimant.

NOTE: The prescribed period for Medicare purposes is extended to age 65 rather than age 60 for DWB cases.

See also:

  • DI 11015.030 - FO Authorization of a Disabled Widow(er)’s Benefit (DWB) Technical or Non-Medical Denial

  • DI 25501.360 - Established Onset in Deemed Entitlement to Di