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Information About Medicare
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| HIB001 |
(1) (2) entitled to (3) .
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| HIB005 |
The monthly (1) for (2) supplemental medical insurance (3) (4)
(5) .
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| HIB011 |
The monthly premium for (1) hospital insurance is (2) . We will bill you each month for (3) .
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| (Optional) |
| MQ03 |
You have not worked long enough under Social Security to receive monthly benefits
or premium-free hospital insurance under Medicare.
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Work under Social Security is figured in credits. Please read the enclosed pamphlet,
“How You Earn Social Security Credits,” which explains how the credits are earned and how many a person needs to receive
benefits.
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To qualify for monthly benefits, you need a total of (1) work credits. For hospital insurance, you need (2) credits. You have earned (3) credits.
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Your Medicare Card
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You may earn the additional credits you need by working under Social Security. If
you earn the credits, you should get in touch with us to apply again.
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What Medicare Will Pay
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| HIB002 |
We will send (1) Medicare card in about 4 weeks. (2) should take this card with (3) when (4) (5) medical care. If (6) (7) medical care before you receive the card, use this letter as proof that (8) covered by Medicare.
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| MH18 |
Hospital insurance will pay most hospital bills and certain post-hospital expenses.
Medical insurance will help pay much of the medical expenses incurred for physicians
and other medical services. This notice shows whether you are entitled to hospital
insurance only, medical insurance only, or both hospital and medical insurance. Benefits
are payable if covered services were rendered on or after the entitlement date shown.
You will receive by mail a health insurance card and a booklet explaining how to use
the card, what services are covered, and the methods of claiming benefits for covered
services. If you are planning changes in any other hospital or medical insurance you
now have, remember that Social Security health insurance coverage will be effective
with the dates shown on this notice.
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If you need help with medical expenses before your health insurance coverage begins,
or if you need aid in meeting medical expenses not covered by your health insurance,
you may want to get in touch with the nearest social services office to see whether
you are eligible under a program of medical assistance.
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Other Social Security Benefits
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Notify any Social Security office immediately if you change your address so that your
health insurance card and any claims or informational material may reach you promptly.
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| CLO002 |
The (1) described in this letter (2) (3) can receive from Social Security. If you think that (4) might qualify for another kind of Social Security benefit in the future, you will
have to file another application.
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Things To Remember For The Future
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| (Optional) |
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If You Disagree With The Decision
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| 3600C |
Your hospital insurance costs less than the regular amount. This is because you are
the (1) of (2) who has at least 30 work credits. Please let us know right away if your marital status
changes.
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3600D
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If you disagree with the decision, you have the right to appeal. A person who did
not make the first decision will decide your case. We will review those parts of the
decision you disagree with and consider any new facts you have. We may also review
those parts you agree with and may make them unfavorable or less favorable to you.
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You have 60 days to ask for an appeal.
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The 60 days start the day after you receive this letter. We assume you got this letter
5 days after the date on it unless you show that you did not get it within the 5-day
period.
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You must have a good reason for waiting more than 60 days to ask for an appeal
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You have to ask for an appeal in writing. We will ask you to sign a Form SSA-561-U2,
called “Request for Reconsideration.” Contact one of our offices if you want help.
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If You Want Help With Your Appeal
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| (Optional) |
| 3100E |
You can have a friend, lawyer or someone else help you. There are groups that can
help you find a lawyer or give you free legal services if you qualify. There are also
lawyers who do not charge unless you win your appeal. Your local Social Security office
has a list of groups that can help you with your appeal.
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If You Have Any Questions
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If you get someone to help you, you should let us know. If you hire someone, we must
approve the fee before he or she can collect it. And if you hire a lawyer, we will
withhold up to 25 percent of any past due benefits to pay toward the fee.
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(2)
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| MG23 |
If you have any questions, call us toll-free at 1-800-772-1213 (1) . We can answer most questions over the phone. You can also write or visit any Social
Security office. The office that serves your area is located at:
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If you do call or visit an office, please have this letter with you. It will help
us answer your questions. Also, if you plan to visit an office, you may call ahead
to make an appointment. This will help us serve you more quickly when you arrive at
the office.
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| MG20 |
If you have any questions, call us at 1-800-772-1213. We can answer most questions
over the phone. If you prefer to visit one of our offices, please check the local
telephone directory for the office nearest you. Or call us and we can give you the
office address. Please have this letter with you if you call or visit an office. It
will help us answer your questions.
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| (1) |