The 1972 Amendments extended HI entitlement to Social Security and Railroad Retirement disability beneficiaries (D-HI) beginning 7/1/73. Anyone entitled to D-HI may also have SMI (D-SMI) for which they must pay the same premium as enrollees age 65 or over.

For Non-citizens/non-residents aliens, review RS 02610.000 for the exceptions to the Alien Nonpayment Provisions. The Alien non payment provisions have a bearing on Social Security Disability entitlement, and as such, they play a role in Medicare entitlement.

In most cases, D-HI entitlement begins after an individual has been entitled (or deemed entitled) to disability benefits (DIB, DWB, or CDB) for 24 months, i.e., D-HI begins with the first day of the person's 25th month of disability benefit entitlement. ( for an explanation of when months of SSI/SSP eligibility can be counted toward the 24 month waiting period for DWBs. see HI 00801.154.)

Even though a cash benefit may not be payable for a particular month, all months of disability benefit entitlement are counted in determining when the 24 month D-HI qualifying period requirement is met, see example in HI 00801.146C.3.

EXCEPTION: Section 115 of the Medicare, Medicaid and SCHIP Benefits Improvement and Protection Act of 2000, waives the 24 month waiting period for beneficiaries whose primary or secondary diagnosis is Amyotrophic Lateral Sclerosis (ALS). The Diagnosis code (either primary (DIG) or secondary (SDIG)) will be 3350.

Since CDB entitlement can begin no earlier than age 18, D-HI entitlement based on CDB entitlement can never begin before the month the beneficiary attains age 20 (or age 18 if the individual’s disability is ALS). This is true even though the individual may have been disabled and entitled to child's insurance benefits for many months prior to age 18, see example HI 00801.146C.4.

These individuals are entitled to D-HI beginning 7/01/01, or the first month of disability benefit entitlement, whichever is later. If a beneficiary is diagnosed with ALS after the initial disability onset date and is within the 24 month Medicare waiting period, the beneficiary is entitled to Medicare effective with the later of the ALS onset month or 7/01/01, see example in HI 00801.146C.7.

Certain surviving spouses who are disabled, but not entitled to disabled surviving spouses's benefits (DWB), may be deemed to be entitled to DWB solely for purposes of establishing or maintaining entitlement to Medicare. For a complete discussion of the deemed DWB provisions, see HI 00801.155.