DI 45001.097 R-HI/R-SMI Entitlement Based on Dialysis, Closed Period
Based on the course of dialysis you received for your kidney condition, you are entitled
to hospital insurance beginning and medical insurance beginning . Under the law, Medicare coverage based on dialysis ends with the last day of the
12th month after the month in which the course of dialysis was discontinued unless
dialysis is resumed or a transplant is received before that date. Since your course
of dialysis was discontinued in , your Medicare coverage ends .
If you believe this determination is not correct, you may request that your case be
reexamined. If you want this reconsideration, you must request it not later than 60
days from the date you receive this notice. You may make this request through any
social security office. If additional evidence is available, you should submit it
with your request.
If you have any questions about your Medicare coverage, you should contact any social
security office. If you visit an office, please take this notice with you.