An individual may establish immediate entitlement to both HI and SMI if the individual:

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  becomes reentitled to title II disability benefits within the time limits specified in HI 00801.152; and

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  received disability benefits for at least 24 months during the earlier period of entitlement.

An individual who becomes reentitled within the time limits specified in HI 00801.152 (with less than 24 months prior disability benefit entitlement) may have such prior months counted toward the 24-month qualifying period during a subsequent period of entitlement to disability benefits.

Medicare eligibility in reentitlement cases may begin before the month the award notice is sent to the individual.

If limited to a choice of paying for retroactive coverage they did not know they had, or refusing SMI altogether, many individuals may refuse SMI.

An individual is deemed to have enrolled for SMI in the third month of the IEP if the individual:

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  files an application for disability benefit reentitlement;

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  is eligible without a waiting period (or has a shortened waiting period) for HI; and

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  is subject to automatic enrollment in SMI.

The individual is awarded coverage beginning with the first month of D-HI entitlement.

At the time of final processing, if more than 5 months' retroactive premiums must be withheld from the initial monthly benefit check, the individual is awarded SMI effective with the month in which final action is taken to process the award.

The individual is also sent a form giving the individual the right to refuse SMI. If the individual refuses SMI by the end of the second month following the month the award notice is mailed, the individual is deemed not to have enrolled and does not incur any premium liability. Any refusal received later than that is treated as a voluntary termination request. (See HI 00805.080 and HI 00820.050.)

Individuals residing in Puerto Rico or outside the U.S. are not subject to automatic enrollment. If such individuals desire SMI coverage, they must specifically request enrollment at the time they file their application for reentitlement to monthly disability benefits.

If the FO fails to secure a SMI election, the PSC should obtain it before the reentitlement award.

The SMI election should preferably be recorded on a CMS-40B, but any written request for enrollment will suffice. If a claim is received which:

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  does not include the claimant's SMI enrollment or refusal, and

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  it is likely at the time of processing that the individual would not otherwise be selected for enrollment solicitation as discussed in HI 00805.115 and HI 00805.120,

an election should immediately be secured from the claimant by the FO.

Individuals alleging a specified onset date are often found to be disabled earlier or later than that date. Because of the uncertainty involved in determining the IEP for an individual filing for reentitlement to disability benefits, the SMI enrollment request is deemed to have been filed in the third month of the IEP. This assures that the enrollee has the opportunity for coverage at the earliest possible date.

In all other respects, the claim is handled in the same way as a claim filed by an individual who is subject to automatic enrollment as described in HI 00805.090B.2. and HI 00805.090B.3.