PM 22-07-01: Hospital Insurance Benefits (HIB) (AABD, TANF)

WAG 22-07-01.

Hospital Insurance Benefits (HIB) are Part A of Medicare and cover institutional services (e.g., inpatient hospital services, skilled nursing facility services, hospice care, etc.) and limited home health care. HIB is free of charge to most eligible persons and is automatic for persons receiving Social Security Retirement, Survivor, Disability benefits (aka RSDI) and/or Railroad Retirement benefits (RRB) (not SSI). Persons who are uninsured for Medicare or who do not receive RSDI or RRB are the only persons who must pay for HIB.

The following are potentially eligible for HIB:

  • a person who is 65 years of age or older;
  • a person under age 65 who has been receiving RSDI or RRB disability benefits for at least 2 years;
  • a person of any age being treated for end stage renal disease (ESRD);and
  • a person of any age who has been diagnosed with Amyotrophic Lateral Sclerosis (ALS), also known as Lou Gehrig's disease.

Persons under age 65 who are ineligible for free Part A cannot buy Part A. Persons who are ineligible for free Part A at age 65 can buy it by paying a monthly premium. Persons who pay a monthly premium for Part A must enroll in Part B, Supplementary Medical Insurance (SMIB).

Persons who buy Part A coverage may only enroll during a prescribed enrollment period. A penalty is added to the basic monthly premium amount if the person was eligible for Part A coverage but failed to enroll during the initial enrollment period.

Persons ineligible for free Part A may also utilize the conditional enrollment process. The conditional enrollment process allows a person to apply for Part A with coverage beginning only if they are determined to be eligible for QMB.