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MEDICAL SERVICES POLICY MANUAL,SECTION F

F 100 Non Financial Eligibility Requirements

F-191 Medicare Part A Entitlement MS Manual 01/01/22 Medicare Part A beneficiaries include the following groups: 1. Persons sixty-five (65) years of age or older who are: a. Entitled to monthly Social Security benefits on the basis of covered work under the Social Security Act, or qualified Railroad Retirement beneficiaries; b. Not entitled to monthly Social Security or Railroad Retirement benefits but meet the requirementsof a special transitional provision (some individuals who are not eligible for regular SSA or Railroad Retirement benefits still qualify for Part A hospital insurance); c. Not entitled to monthly Social Security benefits and not a qualified Railroad Retirement beneficiary butenrolled and paying a monthly premium. To be eligible under this provision, an individual must be sixty-five (65) years of age or older, a U.S. resident, and a U.S. citizen or an alien lawfully admitted for permanent residence who has residedcontinuously in the U.S. for five (5) years, and enrolled for Part B medical insurance or has filed a Part B enrollment request which will entitle the individual to Part B; and d. Conditionally eligible except thatthey are not receiving Part A Medicare because they cannot afford to pay the premium for Part A. 2. Persons under sixty-five (65) years of age who are entitled to or deemed entitled to Social Security disability benefits for twenty-four (24) months (included are workers with disabilities, widow(er)s with disabilities, surviving divorced spouses with disabilities, and individuals entitled to childhood disability benefits) beginning with the twenty-fifth (25th) month of entitlement to such benefits, and certain individuals entitled to Railroad Retirement benefits due to a disability. 3. Persons of any age who have end-stage renal disease (ESRD) who require a kidney transplant or a regular course of dialysis and who are Social Security or Railroad Retirement recipients, orthe spouseor a child of an SSA recipient when the spouseor child has ESRD. Entitlement to Part B Medical Insurance is not an eligibility requirement for Qualified Medicare Beneficiaries (QMB), Specified Low-Income Medicare Beneficiaries (SMB), or Qualifying Individuals 1 (QI-1). An individual must be entitled to Part A for SMB or QI-1 and entitled to or conditionally eligible for Part A to be eligible for QMB.