## Facts

- Plaintiffs were individuals age 65 or older receiving Social Security retirement benefits, which made them automatically entitled by statute to Medicare Part A (hospital insurance).
- Plaintiffs preferred to rely on private insurance and alleged their insurers reduced coverage when the insured was “entitled to” Medicare Part A.
- Plaintiffs did not claim they were required to use Medicare; they acknowledged they could decline to submit Medicare claims.
- Plaintiffs sought declaratory and injunctive relief requiring federal agencies to provide a means to renounce (disclaim) Medicare Part A entitlement while continuing to receive Social Security benefits.
- The government asserted there was no statutory authority permitting an eligible Social Security recipient to sever Medicare Part A entitlement while retaining Social Security benefits.

## Issues

1. Whether individuals age 65 or older who receive Social Security retirement benefits have a statutory right to disclaim their legal entitlement to Medicare Part A while keeping their Social Security benefits.

## Decision

- The court affirmed summary judgment for the government.
- It held that Medicare Part A entitlement automatically attaches by operation of law to persons who are age 65+ and entitled to Social Security benefits.
- The court concluded there is no statutory mechanism allowing a person to terminate Medicare Part A entitlement without also terminating Social Security entitlement (and thus Medicare entitlement).
- The court rejected plaintiffs’ request for a judicially compelled disclaimer process, treating policy objections as matters for Congress.
- Judge Henderson dissented, reading the statutory scheme as not foreclosing a disclaimer option and viewing the agencies’ approach as unduly rigid.

## Legal Principles

- When statutory conditions are met, entitlement to a federal benefit may arise automatically by operation of law, regardless of whether the beneficiary wishes to accept or use the benefit.
- The ability to decline use of benefits (e.g., by not filing claims) is distinct from the legal status of entitlement created by statute.
- Federal courts and agencies may not create an opt-out or disclaimer procedure absent statutory authorization, particularly where Congress has linked eligibility for one program to entitlement under another.
- Agency interpretive guidance consistent with the statutory linkage between Social Security entitlement and Medicare Part A entitlement may be accepted where the statute provides no separate avenue to sever that linkage.

## Conclusion

The D.C. Circuit held that individuals age 65 or older who receive Social Security retirement benefits cannot, under existing law, disclaim their legal entitlement to Medicare Part A while continuing to receive Social Security benefits; any change must come from Congress.


Hall v. Sebelius, 667 F.3d 1293 (D.C. Cir. 2012)