Effective Dates: 10/12/2023 - Present Previous | Next

TN 53 (10-23)

RS 00301.160 Insured Status Based on Medicare Qualified Government Employment

A. Policy for federal employment

Federal employees pay taxes on all wages (subject to the limitations in RS 01401.030) after 12/31/82 for Medicare purposes. Credit these Government Employment Quarters of Coverage's (GEQC) in the same ways as regular QCs.

Federal employees in an employee or employer, relationship with a Federal Agency at any time during 01/83 and before 02/83 will receive deemed government QCs (DQCs) for federal service before 01/83.

Use GEQCs, DQCs, and regular QCs to establish the insured status requirements for Medicare purposes. If the Federal employee is insured using only regular QCs, no further development is required.

B. Policy for deemed QCs (DQC)

1. Prior to 1978

The rules for establishing DCQs for Federal employees are in HI 00801.430.

2. After 1977

To determine DQCs, refer to the increment amounts chart in RS 00301.250. Assume the wages were subject to Federal Insurance Contribution Act (FICA). Establish no more than four DQCs for any year.

Since the insured status requirements for Medicare government employees are the same as for title II benefits, a prior period of disability in which title II benefits were payable or a “freeze” established can reduce the number of QCs needed for Medicare purposes.

See also:

  • •

    RS 00301.105, Fully Insured Status

  • •

    RS 00301.122, Relationship Between Period of Disability and Insured Status, see

  • •

    RS 00301.132, Relationship Between Freeze Insured Status and DIB Insured Status).

If you cannot consider any of the Federal employment wages for SS coverage purposes, do not grant FQCs or DFQCs for this service for Medicare purposes.

C. Policy for state and local employment

Public Law 99-272 extended mandatory coverage for Medicare to certain State and local workers. State and local employees who are not otherwise covered under a voluntary Social Security agreement and employees hired after 03/31/ 86 earn GEQCs for Medicare purposes.

Employees hired before 04/01/86 who are not subject to a coverage agreement may be covered if the State or local employer elects this coverage by modifying the voluntary agreement. However, unlike Federal employees, there is no provision for deemed QCs for any employment prior to 04/01/86.

Credit GEQCs the same way as regular QCs. You may combine GEQCs and regular QCs to quality for Medicare.

D. Policy for the types of Medicare insured status

1. General

Base Medicare entitlement on age or disability.

Use GEQCs, DQCs (Federal employment only), and regular QCs, to determine if the requirements are met. An individual who has worked in Medicare qualified government employment may qualify for hospital insurance on the basis of Medicare qualified government employment exclusively, or a combination of Medicare qualified government employment and Social Security covered employment.

2. Medicare insured status based on age

Apply the fully insured status test for Retirement Insurance Benefits to determine if the individual meets Medicare eligibility at age 65.

3. Medicare insured status based on disability

A number holder (NH) meets the insured status requirement for Medicare entitlement based on disability if they:

  1. a. 

    meet the 20/40 and fully insured requirements discussed in RS 00301.120, or

  2. b. 

    are disabled prior to age 31 and NH meets the special insured status requirements discussed in RS 00301.140, or

  3. c. 

    are blind and NH meets the fully insured requirements discussed in RS 00301.150.

To qualify under the Medicare provision the disabled government employee must meet the requirements for a DIB assuming the government QCs were regular QCs. Meeting the requirements for a freeze only is not sufficient to qualify for Medicare.

EXAMPLE: A blind person would not meet the insured status requirements for a “freeze only” by using the government QCs, would not be entitled to a DIB, and could not qualify for Medicare.

4. End Stage Renal Disease

If the government worker is fully or currently insured, as described in HI 00801.191, they meet the insured status requirement for Medicare for Renal disease (R-HI) for themselves, their spouse, or dependent child. R-HI cannot begin before the first month the worker meets insured status requirement and the person becomes disabled, as discussed in HI 00801.201.

E. Reference

HI 00801.400, Medicare entitlement for government employees

To Link to this section - Use this URL:
http://policy.ssa.gov/poms.nsf/lnx/0300301160
RS 00301.160 - Insured Status Based on Medicare Qualified Government Employment - 10/12/2023
Batch run: 11/08/2024
Rev:10/12/2023