TN 1 (07-04)
DI 45001.343 Notice — R-HI/R-SMI Award Based on Transplant to Premium HI/SMI Beneficiary, Entitlement Dates are the Same or Later Than Premium HI/SMI Coverage (Conversion Notice)
TO REQUEST THIS NOTICE:
Enter on SSA-5002: “Send notice 1083 with 2 fill-ins: and .”
Your application to change the basis of your Medicare coverage has been approved. You are now entitled to Medicare on the basis of your kidney condition and the kidney transplant you received in . Since you were already entitled to Medicare based on the attainment of age 65, there will be no change in the effective dates of your hospital insurance and supplementary medical insurance entitlement. Medicare coverage based on kidney disease did not become available to persons age 65 or older until October 1978, even if the condition existed before October 1978.
Medicare coverage based on a kidney transplant ends the last day of the 36th month after the month in which the transplant occurred unless the person receives a new transplant or begins regular dialysis treatment before that date. Therefore, your coverage based on your transplant ends the last day of , although you may, of course, be eligible to reenroll in your previous Medicare coverage on the basis of having attained age 65. If you require a new transplant or dialysis treatment, please contact any Social Security office.
While you must continue to pay premiums for your supplementary medical insurance, premiums are not charged for hospital insurance based on kidney disease. You will, therefore, be notified later of the change in your Medicare premium rates.
If you have any questions, please contact the people at any Social Security office by telephone or in person. If you visit the office, it would be helpful if you take this notice with you.