TN 29 (08-99)

HI 00801.134 HI Premium Reduction for Aged Individuals With At Least 30 Quarters of Coverage

A. Background

Under section 13508 of P.L. 103-66, individuals age 65 or over who are not insured for monthly title II benefits and/or premium-free HI, but have at least 30 quarters of coverage (QCs), are eligible for a reduction in the amount of their HI premium. In some cases, an individual whose spouse or former spouse has at least 30 QCs can also qualify for HI premium reduction (see B. below).

The amount of the HI premium reduction for months in 1994 is 25 percent. The amount of the reduction increases by 5 percent effective January of each year until the maximum reduction of 45 percent is reached in 1998. See HI 01005.007 for the reduced HI premium amount.

NOTE: Premium reduction also applies to Premium-HI for the Working Disabled. (See HI 00801.170 E. for a discussion of how the reduction applies to the disabled.)

B. Policy-Who is eligible for reduction

An aged individual qualifies for HI premium reduction if he/she:

  • Has 30 or more QCs on his/her own E/R; or

  • Has been married for at least 1 year to a number holder (NH) with 30 or more QCs; or

  • Was married to a deceased NH with 30 or more QCs for at least 1 year prior to the death of the NH; or

  • Is divorced, after at least 10 years of marriage, from a NH who had acquired 30 or more QCs, at the time the divorce became final.

Normal title II development rules apply in determining and allocating QCs and also in determining relationship, divorce and death of the NH. However, it should be noted that the duration of marriage requirements for premium reduction for widow(er)s differs from the duration of marriage requirement for title II widow(er)s benefits.

C. Policy - When QCs may not be counted

The following QCs may not be counted as QCs for purposes of reducing an individual's HI premium:

  • Deemed Government Employees Quarters of Coverage (GEQCs) for Federal employment performed prior to 1983 (see HI 00801.410 B. for a discussion of deemed GEQCs);

  • “Totalization” QCs granted for monthly benefit purposes for work performed under the social security system of another country with which SSA has a totalization agreement. (See GN 01701.115.)

NOTE: Actual GEQCs acquired for Federal employment after 1982 and for State or local government employment after March 1986 are counted in determining whether a NH has at least 30 QCs.

D. Procedure - Verifying eligibility for reduction

1. NH

Verify that the NH has at least 30 QCs.

2. Spouse

For a spouse, obtain:

  • Proof of marriage; and

  • Verification that the NH has at least 30 QCs.

Advise the enrollee to report any change in marital status.

3. Widow(er)

For a widow(er), obtain:

  • Proof of marriage;

  • Evidence of the death of the NH; and

  • Verification that the NH has at least 30 QCs.

4. Divorced spouse

For a divorced spouse, obtain:

  • Proof of marriage;

  • Proof of divorce;

  • Evidence of the death of the NH (if the Premium-HI enrollee is a surviving divorced spouse); and

  • Verification that the NH had at least 30 QCs at the time the divorce occurred.

E. Procedure- Current enrollee

If an individual who is currently entitled to Premium-HI inquires about HI premium reduction, develop as described in HI 00801.134D. Forward all development to the appropriate PC. Annotate the cover sheet in red “Premium-HI Reduction Case.”

F. Procedure - Establishing entitlement

Establish entitlement under the individual's own SSN using the BIC of “M,” even if eligiblity for premium reduction is based on another individual's earnings.

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