Subchapter Preview:

NOTE: The audience for this entire subchapter is: DO/BO/ TSC-CR, CR TII, DRT, FR, OA, OS, RR, SR, TSC-SR; PSC-CRTA, EHS, IES, RECONR; INTPSC-CA, CATA, CDA, CIES, EHS, FCR, HIE, RECONR

Medicare health insurance programs under social security will help pay hospital and medical expenses for most persons 65 and over; for individuals, regardless of age, if entitled to social security disability benefits for more than 2 years; and for insured persons, their dependents and survivors who suffer severe kidney disease requiring dialysis or kidney transplant (see HI 00801.196 ff.). Benefits are generally available, however, only for medical services provided in the United States. The only exceptions are medical services provided in Canada or Mexico to United States residents who either cross the border for facilities closer than those available in the United States, or who suffer a medical emergency in the United States or while traveling in Canada between Alaska and another State and are taken to the closest hospital.

Since enrollment in the SMI program will cost the beneficiary a monthly premium, a special effort is made to ensure that a beneficiary outside the United States does not mistakenly enroll. He should be furnished information about the limitations of the program outside the United States.

Individuals attaining age 65 and disability beneficiaries are automatically enrolled under Part B as they become eligible for Part A hospital insurance coverage. However, this automatic enrollment does not apply to people living in Puerto Rico or foreign countries.

Beneficiaries outside the United States are initially notified of their eligibility for SMI 3 months before the month of their 65th birthday or 3 months before their 24th month of entitlement to a disability benefit. Claimants outside the United States filing for monthly benefits who are within 3 months of age 65 or older may enroll for SMI during a designated enrollment period (see HI 00805.010) by checking the appropriate block on their applications.

To the extent possible, regular enrollment, termination and premium collection procedures will be followed. The following instructions are for the foreign aspects of the health insurance program.