Effective Dates: 07/17/2023 - Present Previous | Next

TN 87 (07-23)

HI 00805.040 Automatic (Deemed) Enrollment - Aged and Disabled Individuals

A. Policy

Subject to the exceptions in HI 00805.050, a person who first becomes entitled to HI after 6/73 is deemed to have enrolled (is “automatically” enrolled) for SMI in accordance with the following rules.

NOTE: Automatic enrollment does not occur if the individual files with SSA a timely refusal of SMI (see HI 00805.055 B.2.).

1. During first 3 months of IEP

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

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    qualifies for HI without an application by attaining age 65 while on the benefit rolls; or

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    qualifies for HI without an application by being entitled for more than 24 months to a disability benefit (DIB, CDB, or DWB); or

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    files during or before the first 3 months of the IEP an SSA or RRB application which establishes entitlement to HI.

The individual becomes entitled to SMI beginning with the first month in which the individual is entitled to HI.

EXAMPLE: James Bennett established entitlement to DIB beginning 7/89 and is entitled to D-HI (HI based on disability) beginning 7/91, James' 25th month of DIB entitlement. James is deemed enrolled in D-SMI in the third month of James' IEP which began 4/1/91 and will be entitled to D-SMI beginning 7/91, the first month of D-HI entitlement.

2. After first 3 months of IEP

a) If a person files the application establishing entitlement to HI in the last 4 months of the IEP or during a GEP, the person is deemed to have enrolled for SMI at the time the HI application is filed.

If the application establishing entitlement to HI is filed after the IEP, but during the GEP , the individual is deemed to have filed the enrollment request on the first day of the current GEP.

b) These individuals will be deemed to have filed in January and the SMI start date will be February.

Example 1 (After 1/1/2023): Bobby Smith attained age 65 in 1/2022 but did not file for monthly benefits and Medicare. In 3/2023, Bobby filed for and was awarded monthly retirement benefits and HI. Bobby did not refuse SMI. Because filing occurred after Bobby's IEP, but during a GEP, Bobby is deemed to have enrolled in SMI on the first day of the current GEP (1/1/2023). Bobby will have SMI coverage beginning 02/1/2023.

Example 2 (After 1/1/2023): If Jane Doe files 1/1/2023 – 03/31/2023 the GEP SMI-START = 02/2023 since we are deeming the filing date to be 01/2023.

Example 3 (After 1/1/2023): If John Doe files 1/1/2024 – 03/31/2024 the GEP SMI-START = 02/2024 since we are deeming the filing date to be 01/2024.

And so on, for any Initial Establishment and SMI-Filing occurring in January-March where the beneficiary is not in an IEP or SEP, the SMI-START is effective February of that same year since we are deeming the filing date to be January of that year.

c) If the application establishing entitlement to HI is filed after the IEP, but not during a GEP or SEP, the individual is deemed to have filed the enrollment request on the first day of the next GEP.

Example 4 (Before 1/1/2023): Mary Hanover did not file for monthly benefits and Medicare when Mary attained age 65 in 9/90. In 11/91, Mary filed and was awarded monthly benefits and HI. Mary did not refuse SMI. Because filing occurred after Mary's IEP, but not during a GEP, Mary is deemed to have enrolled in SMI on the first day of the next GEP (1/01/92) with coverage beginning 7/1/92.

Example 5 (After 1/1/2023): Maggie Winston did not file for monthly benefits and Medicare when Maggie attained age 65 in 5/23. In 7/24, Maggie filed and was awarded monthly benefits and HI. Maggie did not refuse SMI. Because filing occurred after Maggie's IEP, but not during a GEP, Maggie is deemed to have enrolled in SMI on the first day of the next GEP (1/01/25) with coverage beginning 2/1/25.

B. Reference

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    Application filed with a hospital protects automatic enrollment in SMI, HI 00801.027 B.4.

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    Automatic enrollment in R-HI claims, HI 00805.045.

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    Reentitled disability beneficiaries, HI 00805.090.

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    Automatic enrollment is refused but, during the balance of the IEP, the individual submits a request for enrollment, HI 00805.055 B.4.

To Link to this section - Use this URL:
http://policy.ssa.gov/poms.nsf/lnx/0600805040
HI 00805.040 - Automatic (Deemed) Enrollment - Aged and Disabled Individuals - 07/17/2023
Batch run: 07/17/2023
Rev:07/17/2023