If the cessation is reversed on appeal, HI is reinstated fully retroactively. If HI was awarded during the benefit continuation period, a reversal will cause HI to begin earlier if there were months of nonpayment between the original termination and benefit reinstatement, see examples C.1. and C.2.

SMI is affected by reversal of the cessation as follows:

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  If SMI was in effect at the time of termination and during the entire benefit continuation period (or if HI and SMI are initially awarded during the benefit continuation period), SMI is reinstated effective with the month of HI reinstatement, unless the reinstatement results in more than 5 months retroactive premiums. If there are more than 5 months retroactive premiums, see HI 00805.215.

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  If HI, but not SMI, was in effect at the time of termination (or if HI was in effect but SMI continuation is not elected) and SMI was not elected during the benefit continuation period, SMI is not awarded either currently or retroactively because of the reversal.

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  If HI, but not SMI, was in effect at the time of termination and SMI was elected during a GEP or SEP in the benefit continuation period, SMI continues on the basis of the GEP or SEP enrollment. There is no offer of retroactive SMI.

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  If HI was initially awarded during the benefit continuation period but SMI was refused (or elected and allowed to lapse during the benefit continuation period), upon reversal, the beneficiary may only enroll in a GEP or SEP occurring after the reversal.

Gil was entitled to D-HI and D-SMI when DIB terminated 3/31/92. Gil requested reconsideration of the disability cessation, but did not request benefit continuation at that time. In 1/93, was advised there was no basis for reversing the cessation. However, immediately appealed the reconsideration determination and requested continuation of both DIB and Medicare. DIB, D-HI and D-SMI were reinstated effective 1/1/93. The ALJ reversed the cessation and both DIB and D-HI are reinstated effective 4 /1/92. Since more than 5 months SMI premiums would be due if D-SMI were also reinstated effective 4/1/92, Gil is advised if desires D-SMI for the period 4/92-12/92, Gil must file a written request within 60 days of the notice and authorize deduction of the retroactive premiums from the monthly benefits.

Fred's last benefit check was for 1/92, the 20th month of DIB entitlement. Then received benefit continuation from 9/92 through 9/93 when the termination was reversed. Fred had been awarded D-HI and D-SMI as of 1/1/93, the 25th month of combined “actual” and “continuation” benefit entitlement. The revised award will show D-HI beginning retroactively with 6/ 92, the 25th month of DIB entitlement. D-SMI will continue. However, the revised notice will advise that Fred may have D-SMI beginning 6/92, as well, if Fred notifies SSA within 60 days and authorizes deduction of the retroactive premiums from the monthly benefits.

May was awarded D-HI and D-SMI prior to disability cessation. When contacted about benefit continuation, elected only D-HI; refused D-SMI continuation and D-SMI coverage ended with the last day of the month after the month of refusal of D-SMI continuation. If the cessation is reversed, will not be awarded D-SMI along with the D-HI reinstatement.

Evelyn refused D-SMI when entitled to D-HI prior to cessation of disability. Enrolled for D-SMI during a GEP occurring during the benefit continuation period. If the termination is reversed, D-SMI will continue; there will be no retroactive award of D-SMI.