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Determining the Initial Medicare Entitlement
Reason
If initial entitlement is Disability, upon turning 65, the initial reason
changes to Age, per CMS. However, if due to Disability and that
person next becomes dually entitled due to ESRD, then later turns
age 65, Disability is
retained
as the initial entitlement reason. ESRD
entitlement must happen between Disability and Age entitlement
for Disability to be retained as the initial reason.
AGE, then ESRD
Dually entitled at ESRD entitlement
date. Age is the initial reason.
DISABILITY, then ESRD
Dually entitled at ESRD entitlement
date. Disability is the initial reason.
DISABILITY, then AGE
NOT DUALLY ENTITLED!
Disability
record will drop, initial reason changes
to Age.
DISABILITY, then ESRD,
then AGE
Dually entitled at ESRD entitlement
date. Disability is the initial reason.
Does patient have Medicare at ESRD entitlement?
If
NO
, not dually entitled at ESRD entitlement date.
If
YES
, what is the Medicare Part A entitlement date
compared to patient’s age and ESRD entitlement date?