TN 25 (01-24)

HI 00820.015 Termination of Premium-HI for the Aged


Premium-HI for the Aged ends with the earliest of the:

  • Date of death (the HI premium is owed for the month of death, even if the individual dies on the first day of the month).

  • End of the month following the month the individual files a request for termination, unless the termination request is filed in the last month of Part A buy-in coverage or during the 6 succeeding months. In the latter case, Premium-HI ends with the end of the month in which the request is filed.

  • End of the grace period for non-payment of premiums (the last day of the second month following the due date for payment of the premiums; see HI 01001.095).

  • Date SMI coverage ends.

  • Date an individual becomes eligible for HI under either the regular insured or deemed insured provisions.

    NOTE: In the first month of such eligibility, the individual is deemed to have filed an application for entitlement to HI only under the applicable provision.


To terminate Premium-HI, an individual must complete an CMS-1763 (Request for Termination of Premium Hospital and/or Supplementary Medical Insurance). The HI enrollee must specify whether they wish to terminate only Premium-HI or both Premium-HI and SMI.

Generally, the same considerations and limitations that apply to requests for termination of SMI also apply to Premium-HI (see HI 00820.045 - HI 00820.070).

NOTE: An individual covered for Premium-HI under a State buy-in agreement as a QMB may not voluntarily terminate their coverage.


If an individual indicates that the individual wishes to terminate Premium-HI solely because of inability to pay the Part A premium, be sure to discuss with the individual the requirement that States pay Medicare premium, deductible and coinsurance amounts for “qualified Medicare beneficiaries (QMB)” under their Medicaid programs. Refer interested individuals to the State or local Medicaid agency to file for QMB status.


In cases where premium HI terminates because an individual becomes eligible for HI under the regular insured provision, the FO should forward the case via an A101 to the PC of jurisdiction for manual action to convert the premium HI to free HI. Refer to the example in SM 00850.755D


QMBs are individuals entitled to HI (including Premium-HI) whose income does not exceed 100% of the Federal poverty guidelines and whose resources do not exceed twice the SSI resource limit.



Leroy was entitled to Premium-HI beginning 9/87. Leroy died in 5/90 and, in connection with an LSDP claim filed on the spouse's SSN, it was established that Leroy became eligible for RIB in 2/89, but had never filed an application. Leroy is deemed to have filed an application for HI in 2/89. Thus, Leroy's Premium-HI entitlement ended with 1/89 and the premiums Leroy paid for months thereafter are excess premiums which may be paid (or added to survivor benefits). Monthly benefits are not payable since no valid application was filed.


Age 115 Termination, SM 03020.380


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HI 00820.015 - Termination of Premium-HI for the Aged - 01/08/2024
Batch run: 01/08/2024