Premium-HI enrollment should be considered whenever an aged individual filing for benefits under title II or for SSI is ineligible for premium-free HI. Many individuals who are ineligible for premium-free HI but unable to pay HI premiums on their own are at or below Federal poverty levels and can qualify for State payment of Part A premiums under the “qualified Medicare beneficiary (QMB)” program (see HI 00801.139). Such individuals may wish to establish Premium-HI entitlement. Other individuals, although ineligible for State payment of HI premiums, may wish to enroll for Premium-HI because they do not have sufficient health insurance coverage. Depending on the individual's circumstances and the State in which they reside, the FO may be required to:

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  Refer the individual to the State without taking a Premium-HI enrollment (in this case, the State will accrete the individual to its Part A buy-in file; see HI 00801.140D.3.), or

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  Take a “conditional” Premium-HI enrollment if the individual only wants to enroll if the State pays the premiums and make a subsequent referral to the State (State action will change the enrollment from conditional to permanent; see HI 00801.140D.2.), or

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  Take an unconditional enrollment for Premium-HI (most likely to occur for individuals whose income and/or resources are too high to qualify as QMBs; see HI 00801.140D.5.)

To determine whether an enrollment request should be solicited, cover the following points when interviewing an individual who is not insured for premium-free HI:

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  The work history of the individual since last filed an application with SSA (be sure to explore whether or not the individual may qualify for a reduced HI premium on the basis of 30 or more QCs, including as a spouse, surviving spouse, divorced spouse or surviving divorced spouse as discussed in HI 00801.134); and

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  A general description of the Premium-HI provision and the premium cost (including the SMI premium cost); and

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  The requirement that States pay Medicare premiums, deductibles, and coinsurance amounts for QMBs (see HI 00801.139 and HI 00801.140 for a discussion of the QMB provisions).