Identification Number:
HI 00801 TN 41
Intended Audience:See Transmittal Sheet
Originating Office:Centers for Medicare & Medicaid Services (CMS)
Title:Hospital Insurance Entitlement
Type:POMS Transmittals
Program:Medicare,Medicaid
Link To Reference:
 

PROGRAM OPERATIONS MANUAL SYSTEM
Part HI – Health Insurance
Chapter 008 – Requirement for Entitlement and Termination
Subchapter 01 – Hospital Insurance Entitlement
Transmittal No. 41, 12/17/2020

Audience

PSC: BA, CA, CS, DS, IES, ILPDS, IPDS, ISRA, PETE, RECONR, SCPS, TSA, TST;
OCO-OEIO: BET, CR, CTE, EIE, ERE, FCR, FDE, PETL, RECONE, RECONR;
OCO-ODO: BET, BTE, CCE, CR, CST, CTE, CTE TE, DEC, PAS, PETE, PETL;
FO/TSC: CS, CS TII, CSR, CTE, DRT, FR, OA, OS, RR, TA, TSC-CSR;

Originating Component

CMS

Effective Date

Upon Receipt

Background

This is a Quick Action Transmittal and the changes do not introduce any new policy or procedure.

Summary of Changes

HI 00801.008 HI Entitlement for Aged Spouse of Age 62 Worker

Updated reference with new language.

HI 00801.008 HI Entitlement for Aged Spouse of Age 62 Worker

A. Introduction

Effective for age 62 attainments occurring after 8/81, RSI eligibility may not begin earlier than the first month throughout which the individual is age 62.

B. Policy

HI eligibility for the age 65 or over spouse of a 62-year old worker begins with the month an insured worker attains age 62, rather than the first month throughout which the worker is age 62.

Neither the worker nor the spouse need actually establish entitlement to monthly benefits for this provision to apply. If the worker would have been eligible for RIB in the month he/she attained age 62 except for the fact that he/she was not age 62 throughout the month, the age 65 or over spouse can file for and establish entitlement to HI for the month the worker attained age 62.

C. Example

Mr. Mason, DB 12/3/1956, files for reduced RIB in 12/2018. His wife, who is age 67 and uninsured under her own record also files at that time for spouse’s benefits. Mr. and Mrs. Mason's monthly benefit entitlement cannot begin until 1/2019; the first month which Mr. Mason is age 62. Mrs. Mason will be awarded HI as of 12/1/2018, the month her husband attained age 62, provided she meets all the eligibility requirements in that month and provided her husband is insured for that month. Mrs. Mason also has the option of filing for Part B. Normal Part B eligibility requirements apply.

Note: If Mr. Mason did not attain insured status until the 3/2019 quarter, Mrs. Mason could not qualify for HI until 1/1/2019.) Also, Mrs. Mason could file for HI on her own record only and establish entitlement as a “T” beneficiary beginning 12/1/2018; even if her husband does not wish to file for RIB until a later date.

 


HI 00801 TN 41 - Hospital Insurance Entitlement - 12/17/2020