U.S. and foreign coverage cannot be combined to establish entitlement to premium-free HI. However, the fact that a beneficiary is receiving a Totalization benefit does not preclude the beneficiary from qualifying for premium-free HI under certain circumstances. Entitlement to premium-free HI may be established if the Totalization beneficiary:

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  meets the requirements for entitlement to a non-Totalization benefit but the non-Totalization benefit is denied or terminated because of entitlement to a higher Totalization benefit (e.g., entitlement to a Totalization “A” benefit precludes entitlement to a lesser non-Totalization “B” benefit), or

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  is entitled to non-Totalization benefits on a different Social Security number (SSN), or

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  meets the criteria for one of the alternative methods in HI 00801.001 for establishing entitlement to HI.

The following explains how to develop possible entitlement to premium-free HI for Totalization beneficiaries.

A worker is entitled to a non-Totalization benefit with a primary insurance amount (PIA) of $250. The worker’s spouse is entitled to a Totalization benefit on their own SSN with a pro rata PIA of $140. Consequently, the worker's spouse cannot be entitled to a non-Totalization spouse’s benefit on the worker's SSN. However, an application for spouse’s benefits should be taken to establish entitlement to premium-free HI on the worker's SSN. The spouse’s claim would be processed as a technical entitlement with HI involved.

Eligibility requirements for premium HI, HI 00801.131