HI 00801.131 Eligibility for Premium-HI

A. Requirements for entitlement

To become entitled to Premium-HI, an individual must:

  1. have attained age 65 (see GN 00302.005); and

  2. be a resident of the U.S. and either:

    1. a citizen or

    2. an alien lawfully admitted for permanent residence who has resided in the U.S. continuously for the 5-year period immediately preceding the month all other requirements are met; see GN 00303.000ff; and

  3. be ineligible for HI under any other provision; and

  4. already have SMI coverage or be eligible for SMI enrollment and file an enrollment request which will entitle him to SMI (see B. and HI 00801.133) and

  5. file an application for HI during a prescribed enrollment period (see HI 00801.133).

B. Mandatory SMI coverage

An individual may not enroll in Premium-HI without an existing or simultaneous enrollment in SMI. Further, the termination of an individual's SMI coverage requires a simultaneous termination of Premium-HI coverage.

A person enrolled for SMI under a State buy-in agreement, has the right to enroll for Premium-HI during his buy-coverage or during periods of individual SMI coverage after buy-in coverage ends. (see HI 00815.021) Such enrollment must, of course, occur during a prescribed premium-HI enrollment period.

C. First month of eligibility

The first month of eligibility is usually the month the individual attains age 65. However, the first month of eligibility is later than age 65 in the following situations.

  1. The person first meets the citizenship/residency requirements after he attains age 65;

  2. The person's entitlement to monthly RSDI or RRB benefits terminates after age 65 (e.g., because of divorce or remarriage), and he does not qualify for HI under the deemed insured provision.

    An individual's initial enrollment period (IEP) begins 3 months before such first month and continues for 7 months.


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HI 00801.131 - Eligibility for Premium-HI - 04/16/2015
Batch run: 04/16/2015
Rev:04/16/2015