TN 26 (11-14)

HI 00805.115 Enrolling Beneficiaries in SMI who Reside in Puerto Rico

A. Process for enrollment in Supplementary Medical Insurance (SMI)

Each month the Regular Transcript Attainment and Selection Pass (RETAP) Operation identifies records for Medicare entitlement. Five months prior to attaining age 65 and five months prior to the 25th month a beneficiary has entitlement to disability benefits, RETAP establishes only hospital insurance (HI) entitlement on the master beneficiary record (MBR) for beneficiaries who reside in Puerto Rico.

RETAP does not establish Supplementary Medical Insurance (SMI) entitlement for beneficiaries living in Puerto Rico because the law does not allow for automatic enrollment into SMI.

The Social Security Administration (SSA) sends the HI entitlement information to the Centers for Medicare and Medicaid Services (CMS). CMS notifies the beneficiaries about their entitlement to HI and eligibility to enroll in SMI via the Puerto Rican initial enrollment period (IEP) package. CMS mails the Puerto Rican IEP package four months prior to the age 65-attainment month or four months prior to the 25th month of disability benefit entitlement. CMS prints the Puerto Rican IEP package in Spanish, and it contains:

  • Welcome to Medicare letter; and

  • Welcome to Medicare booklet that provides an overview of the Medicare Program.

NOTE: The Medicare card is not included in the Puerto Rican IEP package.

For a detailed description of the Puerto Rican IEP package, see HI 00805.125C.

B. SMI enrollment process during IEP

Beneficiaries residing in Puerto Rico who are automatically entitled to premium-free HI and wish to enroll in SMI during their IEP must complete a Form CMS-40B (Application for Enrollment in Medicare Part B (Medical Insurance)).

This form is available in English and Spanish. Beneficiaries obtain the form in one of the following ways:

  • contacting their local field office (FO);

  • calling the SSA toll-free line; or

  • downloading the form from Medicare’s website.

For exhibits of Form CMS-40B, see SM 00706.265.

Beneficiaries residing in Puerto Rico who are not automatically entitled to premium-free HI can apply for both HI and SMI by filing an application for retirement benefits or Medicare only. For more information on voluntary enrollment in SMI, see HI 00805.110B.

For enrollments outside the IEP, follow instructions in HI 00805.110B.2.

C. FO, Teleservice Center (TSC) and Processing Center (PC) instructions for processing SMI enrollment requests

Follow instructions outlined HI 00805.110D.

D. Issuance of Medicare card for a beneficiary automatically entitled to HI

For a beneficiary that we automatically entitle to premium-free HI, CMS mails the Medicare card reflecting the beneficiary’s entitlement to HI and SMI or HI only, as outlined below:

  • If the beneficiary enrolls in SMI before the first month of eligibility, CMS will mail the Medicare card about four weeks after we process the SMI enrollment request. The card reflects both the HI and SMI entitlement dates.

  • If the beneficiary does not enroll in SMI before the first month of eligibility, CMS mails the Medicare card the month prior to the age 65 attainment month or the month prior to the 25th month of disability benefit entitlement. The card reflects only the HI entitlement date.

  • If the beneficiary enrolls in SMI during the first month of eligibility or during the remaining three months of the IEP, CMS mails the Medicare card about four weeks after we process the SMI enrollment request. The card reflects both the HI and SMI entitlement dates.
    NOTE: In this case, the beneficiary will first receive a Medicare card reflecting only HI entitlement. The beneficiary will then receive a new card reflecting both the HI and SMI entitlements.

For a beneficiary who is not automatically entitled to premium-free HI, CMS mails the Medicare card about four weeks after we process the initial application to Medicare. The card reflects the entitlement dates of either SMI only or both HI and SMI, based on the application processed.

E. References