Section 278 of P.L. 97-248 , (Tax Equity and Fiscal Responsibility Act of 1982) enacted September 3, 1982, provides
for Medicare coverage for Federal employees who
are age 65 (and certain of their auxiliaries/survivors),
are disabled (worker, child (CDB), widow(er) or surviving divorced spouse (DWB)),
have end-stage renal disease (ESRD).
The law, effective January 1, 1983, requires that all wages paid to Federal employees
after December 31, 1982, be taxed the hospital insurance portion of the FICA tax.
Federal employees earn quarters of coverage (QCs) for Medicare purposes through payment
of the tax. In addition, the Federal employees need the same number of QCs to qualify
for Medicare as they would need to qualify under Social Security.
NOTE: For information about coverage for State and local government employees, see DI 23540.001B.
These government employment quarters of coverage (GEQCs) are required to meet insured
status alone, or in combination with Social Security quarters of coverage (SSQCs)
for work in covered employment, to meet the insured status requirements for Medicare.
Further, the law contains a transitional provision that provides that any Federal
employee who was an employee during January 1983 receives deemed GEQCs for his or
her Federal Service prior to January 1983 where there are otherwise insufficient SS
or GEQCs to be insured. Thus, it is possible for Federal employees to meet insured
status in January 1983.
NOTE: The transitionally insured provision is not relevant when the onset of disability
is 10/01/92 or later.
For the disability requirement of the law, treat these MQGE disability claims like
a Title II disability claim subject to the same disability evaluation criteria and
reviews (e.g., medical re-exam, periodic review, etc.). Generally, for a worker or
DWB, the 5-month waiting period and 24 months of disability entitlement must pass
before Medicare coverage can begin. A CDB must be under a disability for 24 months
before Medicare coverage begins. (See also HI 00801.400 - HI 00801.440.)
EXCEPTION: Section 115 of the Medicare, Medicaid and SCHIP Benefits Improvement and Protection
Act of 2000, waives the 24-month waiting period for beneficiaries whose primary or
secondary diagnosis is Amyotrophic Lateral Sclerosis (ALS). The diagnosis code (either
primary (DIG) or secondary (SDIG)) is 3350. See “Amyotrophic Lateral Sclerosis (ALS)
Medicare Waiting Period Waived – Disability Determination Services (DDS)” DI 23580.001.
NOTE: Entitlement to HI due to ESRD begins in accordance with “Date of Entitlement – General
Policy” HI 00801.215.
In addition, months of Supplemental Security Income/State Supplementary Payments (SSI/SSP)
eligibility can be counted toward the 24-month waiting period for DWBs (see “SSI/SSP
Credit for Disabled Widow(er)s” HI 00801.154).
NOTE: Centers for Medicare and Medicaid Services (CMS) is responsible for providing PolicyNet instructions concerning Medicare policy.
If there are any discrepancies between other Program Operations Manual System (POMS)
instructions and the Medicare policy in the HI POMS, the HI POMS take precedence.