PROGRAM OPERATIONS MANUAL SYSTEMPart HI – Health InsuranceChapter 006 – Covered Services (HI-SMI)Subchapter 30 – Medicare Coverage Outside U.S.Transmittal No. 1, 02/26/2020
This POM is being updated to provide the correct information.
This is a Quick Action Transmittal. These revisions do not change or introduce new policy or procedure
Summary of Changes
HI 00630.030 Developing Foreign RSDI Claims When Claimant May Be Eligible for SMI
Rephrased sentences to comply with plain language techniques (e.g. spelled out acronyms, used active voice, etc.).
Added No 05- before 10043
Deleted SSA Publication No. 05-10005, which describes the limitations on medical insurance coverage for medical expenses incurred outside the United States,
In the last paragraph, last sentence added 05- before 10043.
SSA must inform claimants who reside outside the United States and are filing for benefits of their right to enroll for SMI coverage if they are within 3 months of attaining age 65 or older and in an enrollment period. In those rare cases in which claimants do not indicate their age but it appears that they may be near or at least age 65, SSA will furnish this information because we might later determine that they are eligible to enroll.
SSA will forward SSA Publications No. 05-10137 “Your
Payments While You Are Outside the United
and No. 05-10043 “Medicare” with the application, and we will annotate the application to show that we sent the publications. We will delete all references to automatic enrollment to SMI from the application.
If claimants file before their initial enrollment period and become eligible to enroll before SSA adjudicates the claim, we will send a supplemental application, as described above, to obtain their election or rejection of SMI coverage. SSA Publications No. 05-10137 and No. 05-10043 will accompany the supplemental application.