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New Entitlement to Medicare when ESRD Starts After Age 65

New Entitlement to Medicare when ESRD Starts After Age 65 - Patient Resources, Social Work Services Quick Guide, Social Work Manual, Population Specific, Transplant, Kidney Transplant, Financial

Focus

D. POLICY - SMI RIGHTS OF THOSE WHO DEVELOP ESRD

An individual has a new IEP when he/she:
develops ESRD after he/she is entitled to HI based on age or disability, and
• is not entitled to SMI.

The individual is automatically enrolled in R-SMI, along with R-HI, unless he/she refuses R-SMI. The new IEP begins 3 months before and ends 3 months after the first month of R-HI entitlement.

If the individual is already enrolled in SMI based on age or disability, but is paying a premium surcharge for late enrollment, the premium is reduced to the standard rate effective with the first month of R-HI entitlement.

EXAMPLE: Mr. Martinez has been a DIB beneficiary since 2/1996. He refused SMI when he became entitled to D-HI in 2/1998. He filed for SMI in the 2000 GEP and was assessed a 10 percent premium surcharge for late enrollment upon becoming entitled as of 7/1/2000.

In 11/2002, Mr. Martinez began a course of renal dialysis and filed for R-HI. His R-HI is effective with 2/1/2003 and his SMI premium is reduced to the standard amount effective with 2/1/2003.

If Mr. Martinez had not enrolled in SMI during the 2000 GEP, he could also have enrolled in R-SMI effective with 2/1/2003 with no premium surcharge.