TN 1 (02-15)

A. Deemed entitlement to disabled widow(er)’s benefits (DWB) for Medicare Part A Hospital Insurance (HI) coverage

A widow(er) currently entitled to DWB for 24 months is eligible for Medicare HI coverage beginning with the 25^th month of entitlement.

If a widow(er) is ineligible for DWB, he or she may be deemed entitled to DWB for Medicare coverage in certain situations. Deemed DWB entitlement is not for cash benefits. Rather, it allows a widow(er) to satisfy the 24-month qualifying period for Medicare based on disability, or to continue Medicare entitlement as if the individual was entitled to DWB in each month of deemed entitlement.

Medicare entitlement based on deemed entitlement to DWB terminates if an event occurs that terminates the deemed DWB entitlement (see RS 00207.020B.5. and RS 00208.125). Medicare terminates the later of either:

• the month the event occurred; or

• the month following the month we send a notice to the claimant that he or she is no longer entitled to deemed DWB entitlement.

B. Disabled widow(er)s who may be deemed entitled to DWB for Medicare

A disabled widow(er) may be deemed entitled to DWB for Medicare purposes if he or she is:

• not eligible for DWB prior to attainment of age 60; or

• entitled to retirement insurance benefits (RIB) prior to age 65; or

• entitled to mother’s or father’s benefits based on having a child in his or her care and is at least age 50.

C. Deemed entitlement to DWB

1. RIB entitlement after DWB

If a disabled widow(er)’s entitlement to DWB terminates upon entitlement to RIB (before attainment of age 65), he or she is deemed entitled to DWB for Medicare purposes. The claimant continues to be deemed entitled to DWB for Medicare purposes until age 65 or a subsequent event occurs terminating deemed entitlement to DWB. See RS 00207.020B for terminating events.

EXAMPLE:

Mrs. Baker became entitled to HI effective 7/04 based on DWB entitlement, which began 7/02. Her DWB was terminated because of entitlement to RIB effective 12/04, the month she attained age 62. Her entitlement to HI is not affected because DWB entitlement is deemed to continue despite termination upon entitlement to a RIB.

2. Aged widow(er)’s entitlement after DWB

If a disabled widow(er) is entitled to DWB, becomes entitled to aged widow(er)’s benefits prior to age 65, and continues to have a disability, he or she is deemed entitled to DWB for Medicare purposes.

3. Aged widow(er)’s deemed entitlement to DWB at age 60 or over

If a widow(er) becomes entitled to aged widow(er)’s benefits beginning at or after age 60 but before age 65 and alleges a disability, he or she is deemed entitled to DWB for Medicare purposes for each month of entitlement to aged widow(er)’s benefits. Deemed entitlement continues until an event occurs that terminates entitlement to DWB. See RS 00207.020B.5, for termination of Medicare protection.

NOTE: In some cases, a disabled widow or widower eligible for a reduced RIB, which would be greater than the reduced D benefit, will find it advantageous to restrict the scope of the application to D benefits only in the first possible month of entitlement so that D entitlement can be established for at least one month prior to the start of RIB entitlement. Once the D entitlement is established, and it is determined that the beneficiary would have met all the requirements for DWB if not age 60 or over, he or she may be deemed entitled to DWB for the purpose of HI entitlement. Even though D benefits are terminated when entitlement to reduced RIB begins, deemed DWB entitlement continues, enabling the beneficiary to become entitled to HI after 24 months.

EXAMPLE 1:

Mrs. Smith, born in 5/40, filed for and was awarded widow's benefits effective 6/00 the month her husband died. In 12/03, she filed evidence establishing that she was disabled beginning several years before her husband's death. She is deemed, for HI purposes, to be entitled to DWB beginning 6/00 and is entitled to HI beginning 6/02.

EXAMPLE 2:

Mrs. Allen, a disabled widow, inquired about benefits on her husband’s record who died in 10/00. She attained age 62 in 09/00, is fully insured, and wants reduced RIB; she is not currently insured for DIB. Her retirement benefit is greater than what she would receive as a widow and precludes entitlement to DWB and to deemed DWB. Mrs. Allen makes clear on her application that she is filing only for D benefits for the month 10/00; her application for reduced RIB is limited to begin 11/00. Once entitled to D benefits, she can establish deemed entitlement to DWB. Once converted to reduced RIB deemed DWB continues. After 24 months of deemed entitlement to DWB, she becomes entitled to HI beginning 10/02. Upon attaining age 65 in 09/03, Mrs. Allen is entitled to HI under the regular insured provision, and her coverage continues without interruption.

4. Mother or Father’s deemed entitlement to DWB

It is not necessary for a mother or father, who is also a widow(er), to give up their mother or father’s benefits or actually be entitled to DWB cash benefits in order to be entitled to Medicare after 24 months. He or she can file for Medicare, submit proof of disability (such as a completed SSA-3368-BK (Disability Report-Adult)), establish “deemed entitlement” to DWB for the months in which he or she is entitled to mother or father’s benefits, and eligible for DWB.

EXAMPLE:

Mrs. Hall, born in 1944, has an entitled child in her care, and has been receiving E benefits since 9/94, 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 mother's benefits. On 5/24/99, she files an application for HI only and submits evidence of disability. If she meets all DWB eligibility requirements, for purposes of HI, she will be deemed entitled to DWB beginning 5/98, and will be entitled to HI beginning 5/00.

NOTE: A mother or father cannot be simultaneously entitled to both DWB and E benefits; he or she must choose one benefit or the other. A mother or father, who is also a widow(er), can file for DWB entitlement, which terminates mother or father’s benefits and establishes Medicare after 24 months.

D. Related References

• DI 10110.001, Requirements for Disabled Widow(er)’s Benefits (DWB)

• DI 11040.001, Deemed Medicare Cases

• HI 00801.154 SSI/SSP Credit for Disabled Widow(er)s

• HI 00801.155, Deemed Entitlement to DWB for Medicare

• RS 00207.020, Health Insurance (HI) for Disabled Widow(er)s

• RS 00208.001, Mother/Father Definitions and Requirements

• RS 00208.005, Child-in-Care Benefits

• RS 00208.125, Termination of Medicare for Mother/Father Beneficiaries Deemed Entitled to DWB for HI Purposes