Each month the Regular Transcript Attainment and Selection Pass (RETAP) Operation identifies records for Medicare entitlement. Four months prior to attaining age 65 and four months prior to the 25^th month a beneficiary has entitlement to disability benefits, RETAP establishes hospital insurance (HI) and supplementary medical insurance (SMI) entitlement on the master beneficiary record (MBR) for beneficiaries who reside in the United States, the Northern Mariana Islands, the Virgin Islands, Guam and American Samoa.

SSA sends this entitlement information to the Centers for Medicare and Medicaid Services (CMS). CMS notifies these beneficiaries about their entitlement to HI and enrollment in SMI via the domestic initial enrollment period (IEP) package. CMS mails the domestic IEP package three months prior to the beneficiary’s age 65-attainment month or three months prior to the 25^th month of disability benefit entitlement.

The domestic IEP package contains:

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  'Welcome to Medicare' letter;

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  'Welcome to Medicare booklet' that provides an overview of the Medicare Program;

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  Form CMS-40/CMS-1966 (Medicare card/SMI Refusal card) which is the beneficiary’s Medicare card showing the effective dates of HI and SMI entitlement (on the front) and the SMI refusal form (on the back); and

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  Return envelope to mail SMI refusals to the processing center (PC) of jurisdiction.

If we automatically enroll a beneficiary in SMI, the beneficiary has the opportunity to refuse coverage. If the beneficiary does not want SMI coverage, the beneficiary should follow the instructions on the Medicare card and in the 'Welcome to Medicare' booklet to check the appropriate box on the card, sign, and return the card in the enclosed envelope before the effective date. Once we process the SMI refusal, CMS issues a new Medicare card showing the HI entitlement date only. Beneficiaries will receive the revised cards about two weeks after we process the refusal.

For a detailed description of the domestic IEP package, see HI 00805.125B.

For new entitlement cases, automatic enrollment in SMI occurs when we process an application for disability benefits and establish HI entitlement during or after the individual’s IEP.

We enroll (deem) these beneficiaries in SMI and establish the SMI entitlement on the MBR. They do not receive an IEP package. We provide information about HI and SMI entitlement in the SSA award notice. Each beneficiary automatically enrolled in SMI has until a specified date (at least two calendar months after the month in which we mail the notice of SMI coverage) to refuse SMI. For information about refusing SMI enrollment, see HI 00805.055.

Beneficiaries receive their Medicare cards approximately two weeks after we establish the Medicare entitlement. The card shows the effective dates of entitlement to HI and SMI. If the beneficiary refuses SMI, SSA processes the refusal, and CMS issues a new Medicare card showing the HI entitlement date only. Beneficiaries will receive the revised cards about two weeks after we process the refusal.

Automatic enrollment in SMI does not occur when we establish HI entitlement under the following conditions:

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  an application for retirement benefits is filed three months before age 65 or later; or

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  an initial application for Medicare-only based on age is filed. (For information on the Medicare-only applications, see HI 00801.022C.)

We entitle these beneficiaries to premium-free HI; however, they must elect to enroll in SMI. The beneficiary can elect to enroll in SMI when the beneficiary:

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  files an initial application for Social Security monthly benefits and Medicare;

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  files an initial application for Medicare-only; or

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  requests SMI enrollment during a subsequent prescribed enrollment period.

If the beneficiary elects SMI on their initial application, establish SMI entitlement as outlined in HI 00805.040.

These beneficiaries do not receive an IEP package. We send information about HI and SMI entitlement in the SSA award notice.

Beneficiaries receive their Medicare cards approximately two weeks after we process the initial application. The card shows the effective dates of entitlement to HI and SMI unless the beneficiary refused SMI during their application; in which case, the card shows HI coverage only.

Beneficiaries may cancel the SMI enrollment by requesting withdrawal any time before SMI coverage is effective. The PC processes these as a refusal of SMI coverage. For information about withdrawing the enrollment before it goes into effect, see HI 00805.080.

Beneficiaries who are entitled to HI, and currently not enrolled in SMI, must file a request for SMI during a prescribed enrollment period as explained in HI 00805.010. For the enrollment process, see HI 00805.110C of this section.

Process the enrollment request via the Post-entitlement Online System (POS) for a beneficiary in an IEP as discussed in SM 03040.010D, GEP in SM 03040.055, or SEP per SM 03040.065. Approved requests will generate an automated notice to the beneficiary, providing the SMI entitlement date, premium amount if applicable, and a reconsideration paragraph.

If the beneficiary files the enrollment request outside of a prescribed enrollment period as described in HI 00805.010, the POS input will result in a denial. Denied requests generate an automated notice that tells the beneficiary that we denied the request and provides options for filing a request for SMI during a prescribed enrollment period, and a paragraph with information about requesting reconsideration. (SM 03040.065.E.5).

If a beneficiary is currently applying for SMI only and is not eligible for HI or monthly benefits, develop for eligibility using the alternative requirements for SMI in HI 00805.005.A.2 and adjudicate the claim as outlined in GN 01010.008. The beneficiary uses Form CMS-4040 (Request for Enrollment in Supplementary Medical Insurance) to enroll in SMI, as outlined in HI 00805.075B.1.

Take the following actions:

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  Determine if the beneficiary is eligible to enroll in SMI (see HI 00805.005).

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  Offer the option to complete the CMS-40B via telephonic application. See D.3 below for procedures for processing CMS-40B by telephone.

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  If the individual does not agree to complete the form by phone, offer the option to have the Form CMS-40B mailed to them or to get the form online by visiting https://www.cms.gov/medicare/cms-forms/cms-forms/cms-forms-items/cms017339. This is where the beneficiary can find the Form CMS-40B to complete. Offer to email or text the CMS-40B to the caller’s email address, iPhone or Smartphone using the eMailer program.

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  If the beneficiary contacted the FO, and wants to have the form mailed, send the form and include a FO return envelope in the mailing. If the beneficiary contacted the PC, include a return envelope to the PC.

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  Explain to the beneficiary that they can mail, fax, or take the completed form to their local FO for processing.

Take the following actions:

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  Review the Form CMS-40B for completion and possible notes related to the enrollment application. Follow up with the beneficiary if any information is missing as outlined in SM 00706.022.

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  Determine if the beneficiary is eligible to enroll in SMI. For information on SMI eligibility, see HI 00805.005 and for date of filing for a SMI enrollment, see HI 00805.130.

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  Process the SMI enrollment request using procedures in SM 03040.010.

1. a. 

   Does the caller agree to verbal signature via attestation?

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     If yes, proceed with the verbal signature via attestation and explain that we will confirm the caller’s intent to enroll in Medicare Part B. Proceed to Step 3.b.

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     If no, and the caller prefers a paper copy of the CMS-40B form, give the caller the option to:

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       Download and print the CMS-40B form. The CMS-40B is available in both English and Spanish at https://www.cms.gov/Medicare/CMS-Forms/CMS-Forms/CMS-Forms-Items/CMS017339.

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       Receive an email or text of the CMS-40B form to the caller’s preferred email address, iPhone or Smartphone using SSA’s eMailer program.

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       Receive a paper CMS-40B form mailed to the caller’s mailing address with a return envelope to SSA for processing. STOP.

2. b. 

   Access Form CMS-40B. Proceed to Step c.

3. c. 

   Read the scripted attestation language to the caller:

   “During this interview, we will ask you questions that will be used to process [your/or name of claimant's] Application for Enrollment in Medicare - Part B (Medical Insurance), Form CMS-40B, for Medicare Part B. At the end of the interview, we will ask you to confirm the truthfulness of your answers under penalty of perjury and we will record your response. You should be aware that you can be held legally responsible for giving us false information.

   You will receive a notice stating changes to your benefits to retain for your records. Do you understand that you must review all of this information carefully and let us know right away if anything needs to be corrected OR if any of the information changes?"

4. d. 

   Complete applicable fields on Form CMS-40B with the caller. (For instructions on converting CMS-40B to a fillable form or modifying signatures refer to this Verbal Attestation pdf Settings.pdf )

5. e. 

   Obtain proper caller affirmation of intent to verbally sign their request for enrollment in Medicare Part B via Form CMS-40B and understanding of the penalty clause, by reading the following script:

   “Do you understand that the information you have provided will be used to process [your/or name of claimant's] Application for Enrollment in Medicare - Part B (Medical Insurance), Form CMS- 40B? Do you declare under penalty of perjury that this information is true and correct to the best of your knowledge? Do you agree to sign the Form CMS-40B to process your enrollment in Medicare part B?"

1. a. 

   Once the caller agrees to the information, enter the following into the signature block of the form “verbal signature received by, <Technicians Name>, <Office Code>”, record the <Date> in the date section.

2. b. 

   Complete the enrollment by making a POS input if no outstanding development is in progress (e.g., CMS-L564 (Request for Employment Information) or some other proof is needed to verify Group Health Plan (GHP), or Special Enrollment Period (SEP)).

3. c. 

   Inform the caller that they will receive a notice regarding the determination on their enrollment request into Medicare Part B.

4. d. 

   To save the document to the Evidence Portal (EP), click the print icon and under “Printer” select “Microsoft Print to PDF” and then click the “Print” button.

5. e. 

   Save the document in File Explorer with Complete file name using the following naming convention (e.g., JohnSmith CMS40B); Beneficiary Name CMS40B and select Save.

6. f. 

   Click the EP shortcut link in iMain to access EP, type SSN and click the “Next” button.

7. g. 

   Select the document type “CMS 40-B-Medicare Enrollment Application,” add comments if necessary.

8. h. 

   Select appropriate claim filing type.

9. i. 

   Select Import then the “Browse” button.

10. j. 

    Open document in File Explorer and click “Next” to import document.

11. k. 

    Review for accuracy and click “Import Document”.

12. l. 

    Receive confirmation message.

13. m. 

    Review Evidence Portal to ensure the attested CMS-40B is in file by clicking the “View evidence” link.