TN 99 (02-24)

HI 00805.120 Enrolling Beneficiaries in SMI who Reside in a Foreign Country

A. Process for enrolling beneficiaries who reside in a foreign country

Each month the Regular Transcript 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 foreign countries.

RETAP does not establish Supplementary Medical Insurance (SMI) entitlement for beneficiaries living in foreign countries 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 foreign initial enrollment period (IEP) package. CMS mails the foreign IEP package four months prior to the age 65 attainment month or four months prior to the 25th month of disability benefit entitlement. The foreign IEP package contains:

  • Welcome to Medicare letter;

  • Welcome to Medicare booklet that provides an overview of the Medicare program;

  • Form CMS-1739 (Request for Application for Enrollment in Medical Insurance Under Medicare); and

  • Return envelope to mail the Form CMS-1739 to SSA’s Office of International Operations (OIO).


Beneficiaries do not receive their Medicare card in the foreign IEP package. For a detailed description of the foreign IEP package, see HI 00805.125D.

B. SMI enrollment process during IEP

Individuals residing in foreign countries entitled to HI who wish to enroll in SMI during their IEP must complete a Form CMS-40B (Application for Medicare Part B (Medical Insurance)).

This form is available in English and Spanish and can be obtained by calling the Teleservice Center (TSC), by contacting an U.S. Consular office (or U.S. Veterans Administration Regional Office in Manila for beneficiaries living in the Philippines) or by downloading the form CMS-40B from Medicare’s website. For exhibits of the Form CMS-40B, see SM 00706.265.

The foreign IEP package offers beneficiaries two ways to obtain Form CMS-40B if they want to enroll in SMI:

  • complete Form CMS-1739 and send it using the envelope included in the package, or

  • downloading the form CMS-40B from Medicare’s website.

The beneficiary sends Form CMS-1739 to SSA to protect the filing date for the individual requesting SMI as outlined in HI 00805.075. The beneficiary sends the completed Form CMS-1739 to OIO. Upon receipt of Form CMS-1739, OIO mails the beneficiary Form CMS-40B along with a return envelope addressed to OIO. OIO may also contact the beneficiary to offer the availability of the online form, following instructions HI 00805.110D.1. In all cases, instruct the beneficiary to mail the completed form to OIO.

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

C. Procedure for processing SMI enrollment

Follow instructions outlined in HI 00805.110D.2.

D. Issuance of Medicare card

For issuance of the Medicare card, see HI 00805.115D.

E. References

  • HI 00805.005 Eligibility for SMI

  • HI 00805.050 When Deemed Enrollment Does Not Apply

  • HI 00805.075 Prescribed SMI Enrollment Forms

  • HI 00805.110 SMI Enrollment Processes

  • HI 00805.125 Description of CMS Medicare Initial Enrollment Period Package Information Sent to Beneficiaries

  • HI 00805.130 When an Enrollment Received by Mail is Considered Filed

  • SM 00706.265 Exhibits of Form CMS-40B

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HI 00805.120 - Enrolling Beneficiaries in SMI who Reside in a Foreign Country - 02/13/2024
Batch run: 02/13/2024