An individual has a new IEP when the individual:
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•
develops ESRD after
they
are entitled to HI based on age or disability, and
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The individual is automatically enrolled in R-SMI, along with R-HI, unless they refuse
R-SMI. The new IEP begins 3 months before and ends 3 months after the first month
of R-HI entitlement.
If the individual is already enrolled in SMI based on age or disability, but is paying
a premium surcharge for late enrollment, the premium is reduced to the standard rate
effective with the first month of R-HI entitlement.
EXAMPLE: Mr. Martinez has been a DIB beneficiary since 2/96. Mr. Martinez refused SMI at the
time of entitlement to D-HI on 2/98. Mr. Martinez filed for SMI in the 2000 GEP and
was assessed a 10 percent premium surcharge for late enrollment upon becoming entitled
as of 7/1/00.
In 11/02, Mr. Martinez began a course of renal dialysis and filed for R-HI. Mr. Martinez
R-HI is effective with 2/1/03 and the SMI premium is reduced to the standard amount
effective with 2/1/03.
If Mr. Martinez had not enrolled in SMI during the 2000 GEP, Mr. Martinez could have
enrolled in R-SMI effective with 2/1/03 with no premium surcharge.