TN 31 (06-04)
HI 00801.152 Counting Months in Reentitlement Cases
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.).
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.
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. If the two impairments are not directly related, John would have to begin a new 24-month D-HI qualifying period.
4. Change in category of disability benefit
Mary was entitled to DIB for the period 4/95-1/97, a total of 22 months. On 8/6/00, Mary again became disabled but no longer met the insured status requirements for DIB. However, since she was over age 50 and the widow of an insured worker, she was entitled to DWB beginning 2/1/01 after serving the 5-month DWB waiting period. Since Mary had been entitled to DIB during the 60-month period preceding the month of current onset, her D-HI entitlement begins 4/1/01, her 25th month of disability benefit entitlement. If her new period of disability had begun 2/1/02 or later, she would have been required to begin a new 24-month D-HI qualifying period since she would not have been entitled to DIB during the 60 months preceding the month of onset.
5. Disability benefit entitlement prior to 12/80
Mike was entitled to DIB benefits from 1/75 – 3/77. He was entitled to a new period of disability beginning 9/78 and was entitled to D-HI beginning 9/80 after completing a new 24-month qualifying period.