(Medicare General Information, Eligibility, and Entitlement)

 The last day of the 36th month after the month the person receives a kidney transplant.  10.4.5 - Reentitlement for Beneficiaries with ESRD (Rev. 1, 09- 11-02)  If a person whose entitlement based on ESRD has ended begins a new course of regular dialysis or has a kidney transplant, reentitlement begins without a waiting period.  20 - Hospital Insurance Obtained by Premiu m Payment  (Rev. 1, 09- 11-02)  20.1 - Eligibility Requirements (Rev. 1, 09-11-02)  Individuals who want hospital insurance coverage but who are not otherwise eligible (i.e., do not qualify under either the regular or deemed insured provisions, in 10.1, 10.2, 10.3, 10.4 in this chapter) may obtain such coverage by enrolling timely, paying a monthly premium, and upon meeting the following three requirements:   Attaining age 65,   Enrolling or already having enrolled in the SMI program,   Being a resid ent of the U.S., and either:  o A citizen, or   o An alien lawfully admitted for permanent residence who has resided continuously in the U.S. for the 5 years prior to the month of enrollment.  20.2 - Premiums for Hospital Insurance  (Rev. 1, 09-11-02)  Each year, the Secretary of the Department of Health and Human Services announces the amount of the hospital insurance premium payable for each month in the following calendar year.  The applicable premium amount is 33/76 (about 43.4 percent) of the hospital insurance deductible for that calendar year.  The premium is rounded to the nearest $1.  An individual who is not entitled to free Part A and wishes this type of coverage must enroll him/herself during the appropriate enrollment period.  A premium is due for ea ch month of entitlement under Premium HI.   20.2.1 - Premiums Paid by Other Than the Enrollee  (Rev. 11764; Issued 12-22-22; Implementation: 01-01-2023; Effective 01-03-23)  The following subsections describe Medicare Part A premiums paid by other than the enrollee.   20.2.1.1 - Part A Buy -in States  (Rev .11764; Issued 12-22-22; Implementation: 01-01-2023; Effective 01-03-23)  States that include the payment of Medicare Part A premiums for Qualifying Medicare Beneficiaries (QMBs) in their state buy -in agr eements are known as Part A buy -in states. Individuals in Part A buy- in states can file for Premium Part A at any time, without regard to enrollment periods. Late enrollment penalties do not apply. Please see the Manual for State Payment of Medicare Premiums, chapter 1, sections 1.7 and 1.11 for additional information about Part A buy- in states.        20.2.1.2 - Part A Group Payer States  (Rev. 11764; Issued 12-22-22; Implementation: 01-01-2023; Effective 01-03-23)  States that do not include the payment of Medicare Part A premiums for QMBs in their state buy -in agreements are known as  group payer states. To become entitled to Part A, individuals in group payer states can file for premium Part A during their Initial Enrollment Period (IEP) or the General Enrollment Period (GEP). Part A premiums and any applicable late enrollment penalties are paid under a group payer arrangement. Please see the Manual for State Payment of Medicare Premiums, chapter 1, section 1.7 and 1.11  for additional information about Part A group payer states.    20.3 - Beginning of Coverage  (Rev. 1, 09-11-02)  20.3.1 - Initial Enrollment Period (IEP)  (Rev. 1, 09-11-02)  Persons may enroll for premium hospital insurance by filing a request during the IEP which begins the third month before the month of first eligibility and lasts for 7 months.  The individual's IEP for premium hospital insurance is in most cases the same 7-month period as the IEP for SMI.  The individual may enroll for hospital insurance when he or she enrolls for SMI , or later during his or her IEP.  The beginning date of an individual's premium hospital insurance coverage period is determined by the rules applicable to SMI coverage based on an SMI enrollment during an IEP.  (See chapter 2 40 in this chapter.)  20.3.2 - General Enrollment Period (GEP)  (Rev. 1, 09-11-02)  Eligible persons who have not enrolled for premium hospital insurance during their IEP, or whose premium hospital insurance has been terminated, may enroll during a GEP (January 1 - March 31 of each year) if they are enrolling or have enrolled for SMI.  As with SMI, an eligible person who enrolls for hospital insurance during a GEP will have hospital insurance coverage beginning the following July.  The same restrictions on enrollment and reenrollment apply as in the SMI program. Individuals who enroll late may pay a 10 percent premium penalty.  30 - End of Coverage for Hospital Insurance  (Rev. 1, 09-11-02)  A beneficiary's entitlement under the provision terminates:   With the month of the individual's death,   With the last day of the third month following the premium billing month (for nonpayment of premiums),   With the end of the month following the month in which he or she files a voluntary request for termination,   With the month SMI coverage is terminated, or    With the month before the month in which he or she becomes entitled to hospital insurance under the regular or ESRD provisions.  (See 2, 10.4 of this chapter.)  40 - Supplementary Medical Insurance (SMI)  (Rev. 1, 09-11-02)  Unlike the HI benefits program, which is largely financed by compulsory taxes on employers, employees, and the self-employed, the SMI benefits program is a voluntary program financed from premium payments by enrollees, together with contributions from funds appropriated by the Federal Government, and certain deductible and cost-sharing provisions.  40.1 - Eligibility for Enrollment  (Rev. 1, 09-11-02)  To obtain SMI coverage, eligible individuals must enroll in the plan during an enrollment period open to them and pay the required premiums.  They are eligible to enroll if they are entitled to premium- free HI, or are age 65 and resident citizens or resident aliens.  To  qualify as a resident alien, an individual must have been lawfully admitted for permanent residence and have resided continuously in the United States during the 5 years immediately preceding the month of enrollment.   40.2 - Automatic Enrollment in SMI  (Rev. 1, 09-11-02)  Beneficiaries (except those residing in foreign countries or Puerto Rico) are deemed to have enrolled in SMI in the month before the month for which they are entitled to HI so that HI and SMI coverage star t in the same month.  Thus, monthly beneficiaries other than disability beneficiaries are deemed to enroll in the month before attainment of age 65.  Disability beneficiaries are deemed to enroll in the 24th consecutive month of entitlement to disability b enefits.   Every potential "deemed" enrollee is given a reasonable opportunity (at least 2 months) to decline SMI enrollment by filing notice to this effect.  He or she is deemed not to have enrolled and does not incur any premium liability.  A refusal of S MI not timely filed is treated as a request for voluntary termination under existing disenrollment rules once it has been established that the individual does not wish to have SMI.   40.3 - Enrollment Periods (Rev. 12046, Issued:05- 18-23, Effective:01- 01-23, Implementation:06 -21-23)  Enrollment is possible only during specified enrollment periods:    An individual's initial enrollment period (IEP) is of 7 months duration.  It begins 3 full calendar months before and ends 3 full calendar months after the month in which the individual first meets all the requirements for enrollment.    A general enrollment period (GEP) occurs each year from January 1 through March 31. Coverage is effective the month following the month of enrollment.     Special enrollment periods (SEP) are available to enable certain individuals to enroll in Medicare outside of the IEP and the GEP.   40.3.1 - Enrollment During the Individual's Initial Enrollment Period  (Rev. 12046, Issued:05- 18-23, Effective:01- 01-23, Implementation:06- 21-23)  Coverage begins on the first day of:    The month in which the individual first becomes eligible for SMI if enrollment takes place during the first 3 months of the initial enrollment period,    The month following the month of enrollment if enrollment occurs during the fourth through seventh month of the initial enrollment period.  40.3.2 - Enrollment During General Enrollment Period  (Rev. 12046, Issued:05- 18-23, Effective:01- 01-23, Implementation:06- 21-23)  Coverage begins the first day of the month following the month of enrollment.   40.3.3 - Enrollment During the  Special Enrollment Period (SEP)  Related to Coverage Under Group Health Plans  (Rev. 12046, Issued:05- 18-23, Effective:01- 01-23, Implementation:06- 21-23)  If an individual enrolls in SMI or premium HI while still covered under a GHP or LGHP or during the first full month when not enrolled in a GHP/LGHP based on current employment status, coverage begins either with:    The first day of the month of SM I or premium HI enrollment, or    At the individual's option, with the first day of any of the following 3 months.  If the individual enrolls during any of the 7 remaining months of the special enrollment period, coverage begins with the first day of the month following the month of enrollment.   40.3.4 - SEP for International Volunteers  (Rev. 12046, Issued:05- 18-23, Effective:01- 01-23, Implementation:06- 21-23)  Individuals who do not enroll in Part B or Premium Part A when first eligible because they were performing volunteer service outside of the United States may enroll during this SEP.   Eligible Individuals may enroll if:   They volunteered outside of the United States through a program that covers at least a 12- month period; and  Is sponsored by a tax exempt organization; and  The individual has (or had) health insurance that provided coverage to the individual while he or she was outside of the U.S. for the duration of the volunteer service.   The SEP for volunteers is the 6- month period that begins the earlier of the first day of the month following the month for which the:    Individual was no longer serving as a volunteer outside of the United States;   Organization no longer has tax -exempt status; or   Individual no longer has health insurance that provides coverage outside of the United States.   Coverage begins the first day of the month following enrollment.  40.3.5 - SEP for Certain TRICARE Beneficiaries  (Rev. 12046, Issued:05- 18-23, Effective:01- 01-23, Implementation:06- 21-23)  Individuals who enroll in Part A based on disability or ESRD, but do not enroll in Part B because they were eligible for TRICARE standard or TRICARE prime, may enroll during this SEP. Eligible individuals are those who are:   Under age 65, and   Eligible for TRICARE Standard at the time of HI entitlement and:   A military retiree or military retiree family member, or   On active duty or a family member of an active duty service member with Medicare based on ESRD.   Eligible individuals may enroll:   If notified of Medicare entitlement during the IEP - The month after the end of the IEP, or   If notified of Medicare entitlement after the IEP - The month of notification of Medicare entitlement.   Coverage begins:  If notified of Medicare entitlement during the IEP:   The month of enrollment, or   The first month after the end of the IEP   If notified of Medicare entitlement after the IEP:   The month of enrollment, or   The month SMI terminated based on the refusal.   If entitlement is based on ESRD, coverage begins:   The month of HI entitlement, or   The month of enrollment, or   The month after the end of the IEP.  40.3.6 - SEP for Beneficiaries for Whom Medicare is Now the Primary Payer (D -SEP)  (Rev. 12046, Issued:05- 18-23, Effective:01- 01-23, Implementation:06- 21-23)