TN 31 (06-04)

HI 00801.152 Counting Months in Reentitlement Cases

A. Policy

Individuals who are entitled to disability benefits prior to 12/80 must serve a 24-month qualifying period for each period of disability benefit entitlement that begins before 12/80, i.e., months from a previous period of disability benefit entitlement cannot be counted toward the 24-month D-HI qualifying period when an individual is entitled to a new period of disability that begins prior to 12/80 (see HI 00801.152C.5.).

The 1980 Amendments provide that beginning 12/80, months from previous periods of disability benefit entitlement may be counted in determining when the 24-month D-HI qualifying period requirement is met if:

  • a prior period of DIB entitlement ended no more than 5 years (60 months) before the month of current onset; or

  • a prior period of DWB or CDB entitlement ended no more than 7 years (84 months) before the month of current onset; or

  • the current disabling impairment is the same as, or directly related to, the impairment which served as the basis for disability during a previous period of disability benefit entitlement (applies to individuals whose prior period of entitlement ended after 2/29/88); or

  • an individual whose previous disability entitlement ended for non-disability reasons prior to 3/1/88 is reentitled to disability benefits with the same disability onset date. (If the individual's previous period of entitlement ended after 2/29/88, prior months of entitlement may be counted under the preceding rule.)

A person does not have to be reentitled to the same type of disability benefit for these rules to apply.

NOTE: An individual may be required to serve a new disability benefit waiting period without having to serve a new 24-month D-HI qualifying period (see HI 00801.152.C.4.).

B. Procedure

To determine whether the current onset is within the 5 or 7-year period specified above, count back 60 or 84 months beginning with the month prior to the month of current onset.

  • If the individual was entitled to DIB during the 60-month period (or to DWB or CDB during the 84-month period), count all months of disability benefit entitlement in the prior period to determine when D-HI begins.

  • If the prior period ended more than 60 (or 84) months before the current month of onset, do not count the months in the prior period since the individual must begin a new 24-month qualifying period.

C. Examples

1. Prior period ended before 3/1/88

Mark, who became disabled on 3/28/92, was entitled to DIB without a waiting period beginning 4/1/92 because he had a previous period of DIB entitlement which ended less than 60 months prior to the start of his current disability. His previous period of DIB entitlement consisted of a total of 16 months: 10/86-1/88. Mark's D-HI entitlement can begin 12/1/92, his 25th month of entitlement to DIB. If his previous period of entitlement had ended 2/28/87 or earlier, however, he could not have been entitled to D-HI until 4/1/94 since he would not have been entitled to DIB during any of the 60 months prior to the month of current onset.

2. Reentitlement following non-disability termination

Jane, who has been disabled since birth, was entitled to CDB benefits on her disabled father's record beginning 11/83, the month she attained age 18. Since Jane's father recovered from his disability, their entitlement to disability benefits ended 5/31/86. Both Jane and her father were entitled to Medicare at the time of termination. On 9/5/93, Jane's father again became disabled, and both he and Jane were reentitled to disability benefits beginning 3/1/94, after the NH met the 5-month DIB waiting period. Since the NH's prior period of entitlement ended before 3/1/88 and more than 60 months elapsed between the prior termination and current onset, he must serve a new 24-month D-HI qualifying period and his D-HI will begin 3/1/96. Jane, however, can be immediately reentitled to Medicare beginning 3/1/94.

3. Prior period ended after 2/29/88

John's DIB entitlement ended 9/30/00 because he was working. If he becomes disabled again at any time within 60 months of the 9/30/00 termination, the months in the prior period may be counted in determining when D-HI entitlement may begin, regardless of the relationship between the two impairments. However, if John becomes disabled again after the 60-month period, the previous months of DIB entitlement may only be counted if the current impairment is the same as, or directly related to, the previous impairment