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GN 00204: Applications

Effective Dates: 06/07/2013 - Present

TN 58 (05-04)

A. Background

Section 226(a)(2) of the Social Security Act revised the requirements for entitlement to Hospital Insurance (HI) benefits to permit separate filing of applications for HI only. Beginning 1/1/81, individuals can file for HI benefits only on their own SSN or on a NH's SSN to which he/she may be entitled as an auxiliary.

This change in law eliminated inequities experienced when individuals were required to elect monthly benefits to acquire Medicare coverage.

B. Policy

1. General

Eligibility to HI entitlement is tied to monthly benefits. Any individual establishing entitlement to monthly benefits cannot decline HI. HI entitlement is a necessary result of entitlement to monthly benefits for claimants age 65 (see GN 00204.020C.2.).

Generally, the 6 month limitation on retroactivity applies. However, HI 00801.047 and HI 00801.052 outline the guidelines for Deemed Insured HI and explain when an exception to the retroactivity provision applies.

2. Requirements for filing for HI-only

a. Person may qualify for HI-only benefits

A person may qualify for HI-only benefits if:

  • he/she is age 65 or older; and

  • meets all entitlement factors for monthly benefits (except for filing an application).

b. Auxiliary may qualify for HI-only benefits

An auxiliary may qualify for HI-only benefits if:

  • he/she is age 65 or older; and

  • the NH meets all entitlement factors (except for filing an application).

C. Procedure

1. Filing

Follow the procedures below when an individual age 64 years and 9 months or older requests to file an application for HI-only:

  • Ask if he or she wishes to file for both HI and monthly benefits or for HI only;

  • Explain the policy as outlined in GN 00204.021B.;

  • Discuss the effects of earnings; and based on the claimant’s decision take an HI-only application per GN 00204.009, HI 00801.006, and MSOM MCS 005.050; or

  • Take an application for monthly benefits.

NOTE: When full retirement age (FRA) and age 65 differ, it may be necessary for claimants to file a separate application for Medicare and monthly benefits. Often claimants will choose to file for Medicare only and defer filing for benefits until FRA. While it is important to fully explain to claimants their filing options and the effect of their earnings on the amount payable to them before FRA, it is their decision. See GN 00204.039B and GN 00204.040B for the explanation that should be provided to claimants to help them make an informed filing decision.

2. Withdrawal

The claimant may restrict the scope of the application to HI only or withdraw the monthly benefits portion of the application (see GN 00206.020) if it is subsequently determined that entitlement is disadvantageous because earnings preclude benefits.

D. Reference

See HI 00801.027 for development of HI entitlement.

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GN 00203: Interviewing
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GN 002: Applications and Interviews
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GN 00205: Completion of Applications
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