The SMI premium for persons enrolled under the ESRD provision is the same as for aged SMI enrollees. SMI coverage for ESRD beneficiaries is far more expensive, but the extra costs are borne by the government out of general revenues, and do not increase the premiums of other (aged or disabled) enrollees.

As with other enrollees, unless there is State buy-in coverage, the premiums of R-SMI enrollees who receive monthly benefits are deducted from their checks. Nonbeneficiaries are billed and must pay by direct remittance. If the R-SMI enrollee is a minor or an incompetent adult not entitled to monthly benefits, the premium notices may be sent to a premium payer (see HI 01001.225). The grace period for premium payments and the applicability of a premium increase for late enrollment are the same as for other enrollees.

As with D-SMI enrollees, an R-SMI beneficiary paying an increased premium in the month(s) before attainment of age 65 has the premium reduced to the standard amount effective with the month of attainment.