TN 28 (11-14)

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

A. Introduction to CMS Medicare enrollment information sent to beneficiaries

The Centers for Medicare and Medicaid Services (CMS) notifies certain beneficiaries at the beginning of their initial enrollment period (IEP) about their automatic entitlement to hospital insurance (HI) and enrollment in supplementary medical insurance (SMI), if applicable based on where the beneficiary resides, in the IEP package. Beneficiaries receive the IEP package if they are:

  • receiving social security disability insurance (SSDI) benefits for at least four months prior to the 25th month of disability benefit entitlement; or

  • receiving retirement or survivors insurance (RSI) benefits at least four months prior to the month of age 65 attainment.

The Social Security Administration (SSA) automatically enrolls (deems) beneficiaries who reside in the United States and U.S. Territories (except Puerto Rico) in SMI as outlined in HI 00805.110A.1. CMS notifies these beneficiaries of their HI and SMI entitlement.

We do not automatically enroll beneficiaries who reside in Puerto Rico and foreign countries in SMI as outlined in HI 00805.050, HI 00805.115A and HI 00805.120A. CMS notifies these beneficiaries of their HI entitlement and their ability to enroll in SMI.

NOTE: The Railroad Retirement Board (RRB) sends the IEP package and issues Medicare cards to RRB annuitants.

B. Domestic IEP package

CMS sends the domestic IEP package to individuals who:

  • reside in the United States, Guam, the Northern Mariana Islands, American Samoa and the Virgin Islands; and

  • meet the criteria in HI 00805.125A.

CMS mails the IEP package three months prior to the 25th month of disability benefit entitlement or three months prior to the month of age 65 attainment (i.e., the first month of the individual’s IEP). CMS mails the IEP package to the beneficiary’s address of record as recorded on the master beneficiary record (MBR).

1. Contents of the domestic IEP package

The domestic IEP package includes four items:

a. Welcome to Medicare cover letter

This introductory letter informs the beneficiary that he or she:

  • has automatic entitlement to HI and enrolled in SMI;

  • must pay a monthly premium for SMI;

  • should read the enclosed booklet carefully to learn about the important decisions that needs consideration during the IEP; and

  • can stop Marketplace coverage once the Medicare coverage begins, if they have such coverage.

NOTE: If a beneficiary has questions about Marketplace coverage, refer them to the Marketplace website (www.healthcare.gov/medicare/) or 1-800-318-2596. TTY users should call 1-855-889-4325.

For an exhibit of the domestic IEP package cover letter, see HI 00805.126A.

b. Welcome to Medicare booklet

This booklet provides an overview of the Medicare program and outlines the four main decisions new Medicare beneficiaries need to make during their IEP:

  1. keeping SMI coverage;

  2. choosing Medicare coverage (Original Medicare or Medicare Advantage);

  3. enrolling in Medicare Part D (prescription drug coverage); and

  4. enrolling in a Medigap policy, if applicable.

With regard to SMI coverage, the booklet explains items to consider when deciding to keep or refuse SMI coverage, the special enrollment period (SEP) eligibility requirements and ramifications for refusing Part B. It also provides instructions on how to refuse SMI.

Beneficiaries learn about enrollment periods for Medicare Advantage, Part D and Medigap and about assistance programs to help low income beneficiaries such as Supplemental Security Income (SSI), Medicare Savings Programs, Medicaid and the Part D Low Income Subsidy (LIS).

c. Form CMS-40/CMS-1966

Form CMS-40 (Medicare card) is the beneficiary’s official Medicare card reflecting the HI and SMI entitlement dates. Form CMS-1966 (SMI Refusal card) is the SMI refusal form. CMS prints the forms on the same paper. The Medicare card is on the front and the refusal form is on the back.

d. Postage-paid envelope

CMS includes a postage-paid envelope for the individual to use to send their SMI refusal to SSA.

2. SMI enrollment information in the domestic IEP package

The Welcome to Medicare booklet includes critical SMI enrollment information.

a. Refusing SMI coverage

Beneficiaries that we automatically enroll in SMI have the opportunity to refuse the coverage as outlined in HI 00805.055B. In the domestic IEP package, beneficiaries use Form CMS-1966 (which is on the back of the Medicare card) to refuse SMI. The instructions tell beneficiaries to check the appropriate box on the form, sign and return the form along with the Medicare card, to SSA in the envelope provided. The booklet explains that the beneficiary must return the refusal to SSA prior to the effective date of SMI coverage shown on the Medicare card.

b. Subsequent enrollment in SMI

The booklet tells beneficiaries that if they refuse SMI, they may only enroll later during the general enrollment period (GEP) or SEP. The booklet includes a complete explanation of the enrollment periods, including the SEP eligibility requirements, when enrollment may occur and the premium surcharge.

c. SMI enrollment information for TRICARE and CHAMPVA beneficiaries

The booklet specifies that the beneficiary must keep SMI in order to be eligible for TRICARE and CHAMPVA coverage.

NOTE: for information on active duty beneficiaries or their spouses, see HI 00805.325.

C. Puerto Rico IEP package

CMS sends the Puerto Rico IEP package to beneficiaries who:

CMS produces the Puerto Rico IEP package in Spanish and mails it four months prior to the 25th month of disability benefit entitlement or four months prior to the month of age 65 attainment (i.e., the month prior to the first month of the individual’s IEP). CMS mails the Puerto Rico IEP package to the beneficiary’s address of record as recorded on the master beneficiary record (MBR).

1. Contents of the Puerto Rico IEP package

The Puerto Rico IEP package includes two items:

a. Welcome to Medicare cover letter

This introductory letter informs the beneficiary that he or she:

  • has automatic entitlement to HI and may enroll in SMI;

  • can only enroll in SMI during GEP or SEP, if he or she doesn’t enroll during the IEP;

  • must pay a monthly premium for SMI and may have a premium surcharge for enrolling in SMI later;

  • should read the enclosed pamphlet carefully to learn about Medicare coverage options that need consideration during the IEP; and

  • can stop Marketplace coverage once the Medicare coverage begins, if they have such coverage.

NOTE: If a beneficiary has questions about Marketplace coverage, refer them to the Marketplace website (www.healthcare.gov/medicare/) or 1-800-318-2596. TTY users should call 1-855-889-4325.

b. Welcome to Medicare pamphlet

This pamphlet provides an overview of the Medicare program. It includes information on the services and items covered under Medicare, the availability of Medicare Advantage, Medicare Part D and Medigap coverage and the availability of assistance programs to help low income beneficiaries.

NOTE: Beneficiaries do not receive their Medicare card in the Puerto Rico IEP package. The Medicare card for beneficiaries residing in Puerto Rico is made of plastic and does not look like the paper cards. CMS sends it separately from the IEP package.

2. SMI enrollment information in the Puerto Rico IEP package

All SMI enrollment information is in the Welcome to Medicare cover letter. For exhibits of the Puerto Rico IEP package cover letter in Spanish and English back-translation, see HI 00805.126B and HI 00805.126C.

a. Enrolling in SMI

The cover letter tells beneficiaries to enroll in SMI by:

  • downloading Form CMS-40B (Application for Medicare Part B (Medical Insurance)) from Medicare’s website to complete and return to their local field office (FO),

  • contacting their local FO, or

  • calling the Teleservice Center (TSC).

b. Subsequent enrollment in SMI

The booklet tells beneficiaries that if they refuse SMI, they may only enroll later during the GEP or SEP. The cover letter includes a complete explanation of the enrollment periods, including the SEP eligibility requirements, when enrollment may occur and the premium surcharge.

c. SMI enrollment information for TRICARE and CHAMPVA beneficiaries

The cover letter specifies that the beneficiary must keep SMI in order to be eligible for TRICARE and CHAMPVA coverage.

NOTE: For information on active duty beneficiaries or their spouses, see HI 00805.325.

D. Foreign IEP package

CMS sends the foreign IEP package to individuals who:

CMS mails the foreign IEP package four months prior to the 25th month of disability benefit entitlement or four months prior to the month of age 65 attainment (i.e., the month prior to the first month of the individual’s IEP). CMS mails the foreign IEP package to the beneficiary’s address of record as recorded on the master beneficiary record (MBR).

1. Contents of the foreign IEP package

The foreign IEP package includes four items:

a. Welcome to Medicare cover letter

This introductory letter informs the beneficiary that he or she:

  • has automatic entitlement to HI and may enroll in SMI;

  • can only enroll in SMI during the GEP or a SEP, if he or she doesn’t enroll during the IEP;

  • must pay a monthly premium for SMI and may have a premium surcharge for enrolling in SMI later; and

  • should read the enclosed pamphlet to learn about Medicare.

The letter also explains that Medicare generally does not cover medical care received outside the U.S. or its territories.

b. Welcome to Medicare pamphlet

This pamphlet provides an overview of the Medicare program. It includes:

  • information on the services and items covered under Medicare;

  • enrollment criteria for Medicare Advantage, Medicare Part D and Medigap coverage; and

  • the availability of obtaining more information on Medicare's website or from a U.S. Consular office.

NOTE: Beneficiaries do not receive their Medicare card in the foreign IEP package. The Medicare card for beneficiaries residing in foreign countries is the standard paper Medicare card. CMS sends it separately from the IEP package.

c. Form CMS-1739

CMS includes Form CMS-1739 (Request for Application for Enrollment in Medicare Part B (medical insurance)) for beneficiaries to request a Form CMS-40B. For additional information regarding the use of this form, see HI 00805.075B.5. and