Effective Dates: 07/29/2026 - Present Previous | Next

TN 179 (07-26)

GN 00204.021 Separate HI Filing

A. Background

Section 226(a)(2) of the Social Security Act revised the requirements for entitlement to Hospital Insurance (HI) benefits to permit separate filing of applications for HI only. Beginning 1/1/81, individuals can file for HI benefits only on their own SSN or on a NH's SSN to which they may be entitled as an auxiliary.

This change in law eliminated inequities experienced when individuals were required to elect monthly benefits to acquire Medicare coverage.

B. Policy

1. General eligibility to HI entitlement

Eligibility to HI entitlement is tied to monthly benefits. Any individual establishing entitlement to monthly benefits cannot decline HI. HI entitlement is a necessary result of entitlement to monthly benefits for claimants age 65, see GN 00204.020D.1.a.

Generally, the 6 month limitation on retroactivity applies. However, instructions outline the guidelines for Deemed Insured HI and explain when an exception to the retroactivity provision applies, see HI 00801.047 and HI 00801.052.

2. Requirements for filing for HI-only

a. Person may qualify for HI-only benefits

A person may qualify for HI-only benefits if:

  • •

    they are age 65 or older; and

  • •

    meet all entitlement factors for monthly benefits (except for filing an application).

b. Auxiliary may qualify for HI-only benefits

An auxiliary may qualify for HI-only benefits if:

  • •

    they are age 65 or older; and

  • •

    the NH meets all entitlement factors (except for filing an application).

C. Procedure for filing and withdrawal applications

1. Filing an application for HI-only

Follow the procedures below when an individual age 64 years and 9 months or older requests to file an application for HI-only:

  • •

    Ask if they wish to file for both HI and monthly benefits or for HI only;

  • •

    Explain the policy as outlined in GN 00204.021B;

  • •

    Discuss the effects of earnings; and based on the claimants decision take an HI-only application per GN 00204.009 and HI 00801.006, or

  • •

    Take an application for monthly benefits.

NOTE: When full retirement age (FRA) and age 65 differ, it may be necessary for claimants to file a separate application for Medicare and monthly benefits. Often claimants will choose to file for Medicare only and defer filing for benefits until FRA. While it is important to fully explain to claimants their filing options and the effect of their earnings on the amount payable to them before FRA, it is their decision. For the explanation that should be provided to claimants to help them make an informed filing decision see GN 00204.039B and GN 00204.040B.

2. Withdrawal application for Title II benefits

In situations where the claimant files an application (i.e., the application is signed/attested) but later requests to receive Medicare only, he or she must withdraw the application for Title II benefits. The withdrawal can be either before or after adjudication. For processing the withdrawal see GN 00206.011 and GN 00206.014.

NOTE:A withdrawal is not required if the claimant changes his or her filing decision to Medicare-Only before signing the application. For MCS claims, you can restrict the application by selecting "Yes" to filing for Medicare only on the ADDB screen.

D. Reference

HI 00801.027 development of HI entitlement

To Link to this section - Use this URL:
http://policy.ssa.gov/poms.nsf/lnx/0200204021
GN 00204.021 - Separate HI Filing - 07/29/2026
Batch run: 07/29/2026
Rev:07/29/2026