TN 31 (06-04)

A. Introduction

“Cures” of ESRD through kidney transplantation are not always permanent because of organ rejection. Since individuals who have had ESRD in the past may have lost time from work, a special “HI freeze” has been developed to help them meet the quarters of coverage (QC) requirement for reinstatement of Medicare entitlement when they return to dialysis or have another transplant.

B. Policy

The “HI freeze” is considered during adjudication in those rare situations in which, for lack of insured status, R-HI might have to be denied an otherwise eligible claimant with a previous period of R-HI entitlement.

The HI freeze begins with the quarter in which a regular course of dialysis began and insured status was met, and continues through the last quarter of entitlement to R-HI.

If entitlement was based on transplant, the “HI freeze” begins with the quarter in which the transplant occurred and insured status was met, or with as many as two months earlier than that if “early entitlement” based on transplant is involved.

For R-HI purposes only, any quarter, part or all of which fall in this period, is not counted in determining currently insured status, but any QCs earned during this period are credited to currently (or fully) insured status.

Furthermore, any year, part or all of which falls in this period, is not counted in determining the number of elapsed years for fully insured status purposes, although QCs earned are counted.

NOTE: The “HI freeze” applies to the earnings record of the R-HI beneficiary only. It does not apply to the earnings record of the spouse or parent.

C. Example

Miss Jones, born 4/10/62, was currently insured when she began a course of dialysis in 8/96. R-HI began 11/1/96 and was terminated 4/30/00 because of her transplant in 4/97. In 4/01, her transplanted kidney failed and she again began a regular course of dialysis.

For purposes of determining her currently insured status as of 4/01, none of the 16 quarters that fell during the period 7/96 through 6/00 are counted against her.

If she has 6 QCs during the period 4/94 through 6/01, she is currently insured for R-HI. Similarly, in determining fully insured status, the 5 years, 1996 through 2000, are not counted against her. Since she attained age 21 in 1983, she needs only 12 QCs to be fully insured for R-HI as of 4/01. QCs are counted whenever acquired (including the years 1996 through 2000) to determine whether she is fully insured for R-HI.

D. Reference

Insured Status, RS 00300.000