TN 27 (05-94)

A. Background

There are instances when a person needs assurance of his/her Medicare entitlement before a formal determination is made in order to obtain urgently needed health care.

B. Policy — General

Within the limits of the following procedures, SSA FOs may issue temporary notices of HI/SMI eligibility for an individual who meets all requirements for entitlement but has not yet received an award notice or Medicare card. As a result of systems enhancements, temporary notices should rarely be issued. The initial claims process passes information to CMS systems on a daily basis.

Since equitable relief is not available for premium-free HI, it is important that notices only be issued where all requirements for issuance are met.

C. Policy — Requirements for issuing the notice

A temporary notice may only be issued if all the following requirements are met:

• There is a compelling need for the notice (i.e., the claimant is in the hospital when he/she files, plans to enter the hospital in the immediate future or requires medical care at the time of, or shortly after, filing and covered services are likely to be denied without some evidence of Medicare eligibility); and

• Evidence submitted establishes that an individual age 65 or over meets all requirements for HI entitlement as an insured person or meets all requirements for SMI entitlement; and

• No Medicare enrollment data base record (EDB) has ever been established for the person.

(See HI 00901.205 for procedures to replace a lost or stolen Medicare card).

D. Policy — When notice may not be issued

Temporary notices of eligibility may not be issued to (or on behalf of) persons who are:

• Under age 65 (i.e., those eligible under the disability or ESRD provisions);

• Eligible for Medicare only as qualified railroad retirement beneficiaries (QRRBs);

• Enrolling in Premium-HI;

• Already or previously entitled to Medicare; or

• Deceased.