TN 19 (03-93)

A. Background

Beginning 1/78, residents of the Northern Mariana Island (NMI) are treated as U.S. residents for purposes of determining their eligibility for entitlement to Medicare under those provisions not requiring that the individual be fully or currently insured (i.e., SMI, Premium-HI, and HI for the deemed insured). This is in accordance with P.L. 94-241 which extended commonwealth status to the NMI upon termination of the United Nations Trusteeship Agreement for the Trust Territory of the Pacific Islands.

Effective 1/87, after the NMI became a U.S. Commonwealth, the trust funds of the U.S. and NMI social security systems were merged. Certain NMI residents then became eligible for title II benefits based on their earnings under the two systems.

B. Policy - Uninsured individuals

Beginning 1/78, any NMI resident who is an NMI citizen is considered to be a U.S. citizen. A qualified resident alien in the NMI is considered to be an alien lawfully admitted to the U.S. for permanent residence.

NOTE: See GN 00303.120 A. 6. for specific requirements an NMI resident must meet to qualify under the citizen or alien provisions that apply to Special-Age 72 payments.

These same requirements apply to Medicare for the uninsured or deemed insured, and can be used to qualify an NMI resident under the usual SMI and Premium-HI entitlement requirements relating to being a citizen or alien as shown in HI 00805.005 and HI 00801.131 (or, for the deemed insured, in HI 00801.047ff.).

C. Policy - Insured individuals

Any NMI resident who is insured for title II benefits solely on the basis of U.S. social security covered earnings is entitled to HI and enrolled for SMI like any other aged or disabled title II beneficiary.

Any NMI resident who becomes eligible for monthly title II benefits solely because of the merger of the trust funds in 1/87, also becomes eligible for HI beginning with the first month after 12/86 in which he/she is age 65 and eligible for title II benefits.

Although NMI residents eligible for title II benefits as a result of the merger are paid benefits from a special monthly payment tape not associated with the MBR, they are entitled to HI on the MBR as “T” beneficiaries.

NOTE: This assures that a HI master record is established and a Medicare card issued. This group of beneficiaries is billed for SMI premiums.

NMI residents who become eligible for title II benefits solely because of the merger are subject to automatic enrollment in SMI, but they must execute a SMI enrollment because of the special procedures being used to establish their entitlement. A delay in executing an enrollment will not, however, result in loss of months of SMI coverage. These beneficiaries will be deemed to have enrolled in the 3rd month of the IEP with coverage effective with the month of eligibility.

Where such an award of SMI results in a premium arrearage of more than 5 months, SMI is awarded with the month the award is processed and the individual is given the option of electing full retroactive coverage (see in HI 00805.195).

D. Policy - SMI premiums

The first month countable in determining whether an NMI resident must pay an increased SMI premium was 1/87. This means that the earliest that a premium increase applied to NMI residents was 7/88 (based on a 1988 GEP request).