If the claimant is alive on the first day of the month in which the subsidy application
is filed, but dies before SSA processes it, a subsidy eligibility determination is
required from the filing date month through the month of death, if the information
obtained shows the claimant was enrolled in a PDP. If the claimant was not enrolled
in a PDP in the month the application was filed, and dies in that month, the application
should be canceled.
In a couple’s case, if one member of the couple dies before the application is processed
but the deceased spouse was enrolled in a PDP in the month of filing, a subsidy eligibility
determination is required from the filing date month through the month of death. The
deceased spouse’s income is used to determine the living spouse’s subsidy for the
month of filing through the month of the deceased spouse’s death. If the deceased
spouse was not enrolled in a PDP in the month of filing and subsequently dies in that
month, an eligibility determination is not required. The couple’s application should
be canceled and an individual application should be created for the living spouse.
Since enrollment in a PDP could not occur before the next month, determining the deceased
spouse’s LIS eligibility would not be necessary.
When verification is required:
Contact the third party, if one is named on the subsidy application to resolve the
If the third party is unresponsive or unable to reconcile the discrepancy, contact
the living with spouse, if one is named on the subsidy application.
If neither is named or the named third party/spouse cannot reconcile the discrepancy,
use Agency data to make the determination.
Follow the procedures in HI 03035.006C. and HI 03035.006C.1. when contacting the third party and/or a living with spouse named on the application,
with the exception of the last bullet in HI 03035.006C.2. Agency data will be used, if the contacts are unsuccessful or there is no one
EXCEPTION: A subsidy determination is not required if death occurred before:
The effective date of Part D enrollment. Policy - Subsequent Applications