TN 25 (09-93)
HI 00801.155 Deemed Entitlement to DWB for Medicare
Certain widows and widowers whose DWB terminates upon entitlement to a non-disability benefit or who elect to file for a higher non-disability benefit may be deemed to be entitled to DWB in order to establish entitlement to Medicare. Deemed DWB entitlement enables the individual to satisfy the 24-month qualifying period for D-HI entitlement or to continue D-HI entitlement as if actually entitled to DWB in each month of deemed entitlement.
B. List of persons who may be deemed entitled to DWB
The following disabled widow(er)s may be deemed entitled to DWB:
1. DWB followed by RIB or D
A DWB may, if otherwise eligible, elect to receive a reduced RIB at any time between ages 62 and 65. When DWB terminates upon entitlement to RIB, DWB entitlement is deemed to continue until attainment of age 65 or until the occurrence of a DWB termination event. (See example E.1.)
Also, if a DWB becomes entitled to D benefits prior to age 65 and her disability continues, she is deemed to remain entitled to DWB.
2. D beginning at age 60 or later
A person who becomes entitled to D benefits at or after age 60 and furnishes proof of disability is deemed to be entitled to DWB for each month of D entitlement.
Although delay in submitting evidence of disability should be avoided, it will not result in loss of months of deemed DWB entitlement. The effective date of deemed DWB entitlement for a person entitled to D benefits depends on the date DWB could have begun, not on when evidence of disability is submitted. (See example E.2.)
In some cases, it will be advantageous for a disabled widow(er) who is eligible for a reduced RIB greater than the reduced D benefit to also file for D benefits in order to be deemed entitled to DWB. In such a case, the application for D benefits is restricted to the first month of D eligibility and the RIB application is restricted to begin with the following month. This permits D entitlement to be established for at least one month prior to the start of RIB entitlement. Based on the D entitlement, the widow(er) may be deemed entitled to DWB and D-HI awarded with the 25th month of deemed DWB entitlement. (See example E.4.)
3. E beneficiary
An E beneficiary who is disabled and applies for D-HI is deemed to have filed for DWB and is deemed entitled to DWB for each month of E entitlement in which DWB eligibility requirements are met.
In the case of E beneficiaries, the application for D-HI can be effective for purposes of beginning the 24 month D-HI qualifying period up to 12 months prior to the month of filing (i.e., the earliest D-HI can begin based on such an application is twelve months after filing). (See example E.3.)
If an individual filing for, or already entitled to, D or E benefits alleges disability, explain the advantages of Medicare and the advisability of filing for deemed DWB entitlement. If the individual wishes to file for deemed DWB entitlement:
Take an SSA-3368-BK marked prominently “Application as a disabled widow(er) for HI only” (see DI 11005.025);
Undertake the development normally taken to establish DWB entitlement (see RS 00207.004 and RS 00207.007);
Forward the SSA-3368-BK and related DWB development in accordance with DI 11015.000ff. and DI 11040.000ff.
NOTE: If the individual is also filing for D or E benefits, do not delay processing the monthly benefit claim pending development of the deemed DWB claim.
1. RIB after DWB
Mrs. Allen was entitled to D-HI effective 7/1/92 based on DWB entitlement which began 7/90. Her DWB was terminated upon entitlement to RIB effective 12 /92, the first month throughout which she was age 62. Her D-HI entitlement is not affected because DWB entitlement is deemed to continue despite the termination of DWB entitlement upon entitlement to a higher RIB.
2. D at age 60 or later
Mr. Smith, born in 5/29, was entitled to widower's benefits effective 6/ 89, the month his wife died. In 12/92, he filed evidence establishing that he was disabled several years prior to his wife's death. He is deemed, for D-HI purposes, to be entitled to DWB beginning 6/1/89. He may be entitled to D-HI beginning 6/1/91. As indicated in C.2. above, Mr. Smith's delay in submitting evidence of disability does not result in loss of months of D-HI entitlement.
3. E beneficiary
Mrs. Hall, born in 1937, has an entitled child in her care, and has been receiving E benefits since 9/87, when her husband died. At that time she had been severely disabled for many months, but did not file for DWB because of her eligibility for E benefits. On 5/24/92, she files an application for D-HI and submits evidence of disability. If she meets all DWB eligibility requirements, for purposes of D-HI, she will be deemed entitled to DWB beginning 5/1/91 and will be entitled to D-HI beginning 5/1/93.
4. Filing for D benefits prior to RIB
Mrs. Jones, completely disabled, inquired at a FO about her benefit rights when her husband died in 10/90. She attained age 62 in 10/90, is fully insured, and wants reduced RIB. She does not meet DIB insured status. Her deceased husband's PIA is less than her own, and entitlement to a reduced RIB will preclude entitlement to D benefits. Although disabled, she can only be entitled to D-HI if she is deemed entitled to DWB for 24 months. Thus, in addition to filing for RIB, Mrs. Jones files an application for D benefits on which she makes clear that she is filing for D benefits only for the month of 10/90; her application for RIB is restricted to begin 11/1/90. Mrs. Jones is deemed entitled to DWB beginning 10/1/90. Her deemed DWB entitlement continues after D benefits are terminated and she becomes entitled to D-HI beginning 10/1/92, her 25th month of deemed DWB entitlement. Upon attaining age 65 in 10/93, she is entitled to HI under the regular insured provision and her coverage continues without interruption.