Premium-HI enrollment should be considered whenever an aged individual filing for
benefits under title II or for SSI is ineligible for premium-free HI. Many individuals
who are ineligible for premium-free HI but unable to pay HI premiums on their own
are at or below Federal poverty levels and can qualify for State payment of Part A
premiums under the “qualified Medicare beneficiary
(QMB)” program (see HI 00801.139). Such individuals may wish to establish Premium-HI entitlement. Other individuals,
although ineligible for State payment of HI premiums, may wish to enroll for Premium-HI
because they do not have sufficient health insurance coverage. Depending on the individual's
circumstances and the State in which they reside, the FO may be required to:
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Refer the individual to the State without taking a Premium-HI enrollment (in this
case, the State will accrete the individual to its Part A buy-in file; see HI 00802.140E.3.), or
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Take a “conditional” Premium-HI enrollment if the individual only wants to enroll if the State pays the
premiums and make a subsequent referral to the State (State action will change the
enrollment from conditional to permanent; see HI 00801.140E.2.), or
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Take an unconditional enrollment for Premium-HI (most likely to occur for individuals
whose income and/or resources are too high to qualify as QMBs; see HI 00801.140E.5.)