In most cases, D-HI entitlement begins after an individual has been entitled (or deemed
entitled) to disability benefits (DIB, DWB, or CDB) for 24 months, i.e., D-HI begins
with the first day of the person's 25th month of disability benefit entitlement. (
for an explanation of when months of SSI/SSP eligibility can be counted toward the
24 month waiting period for DWBs. see HI 00801.154.)
NOTE: Prior to 12/1/80, the 24 months had to be consecutive, see example in HI 00801.146C.2.
Even though a cash benefit may not be payable for a particular month, all months of
disability benefit entitlement are counted in determining when the 24 month D-HI qualifying period requirement is
met, see example in HI 00801.146C.3.
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)) will be 3350.
Since CDB entitlement can begin no earlier than age 18, D-HI entitlement based on
CDB entitlement can never begin before the month the beneficiary attains age 20 (or
age 18 if the individual’s disability is ALS). This is true even though the individual
may have been disabled and entitled to child's insurance benefits for many months
prior to age 18, see example HI 00801.146C.4.
These individuals are entitled to D-HI beginning 7/01/01, or the first month of disability
benefit entitlement, whichever is later. If a beneficiary is diagnosed with ALS after
the initial disability onset date and is within the 24 month Medicare waiting period,
the beneficiary is entitled to Medicare effective with the later of the ALS onset
month or 7/01/01, see example in HI 00801.146C.7.
Certain surviving spouses who are disabled, but not entitled to disabled surviving
spouses's benefits (DWB), may be deemed to be entitled to DWB solely for purposes
of establishing or maintaining entitlement to Medicare. For a complete discussion
of the deemed DWB provisions, see HI 00801.155.