Refer Railroad Retirement Board (RRB) annuitants that inquire about SMI enrollment to the nearest RRB field office. Obtain the appropriate RRB Field Office and search using the Zip code locator. Tell the beneficiary that the RRB will process the SEP request.

When a beneficiary is filing an initial application for SMI only or for SMI and HI (including premium-HI) simultaneously, process the award via the Modernized Claims System (MCS).

If a beneficiary files for HI and SMI after the Initial Enrollment Period (IEP), process the SMI award as part of the monthly benefit or the HI claim via MCS.

Example of processing the SEP enrollment request in an initial claim for monthly benefits:

Mr. Adell, who attained age 65 in February 2012, has coverage under a GHP based on his own employment since 1998. In October 2014, he files an application for monthly benefits and HI because he plans to retire at the end of that calendar year. Mr. Adell elects SMI coverage effective January 2015. We process the SEP enrollment via MCS as part of the monthly benefit claim.

If the beneficiary is already entitled to HI, process the SMI SEP enrollment via the Post-entitlement Online System (POS). Although we generally use Form CMS-40B (Application for Enrollment in Part B (Medical Insurance)) for these enrollments, a signed and dated statement such as, “I want to enroll for Part B of Medicare” is also acceptable.

SEP enrollment requests for beneficiaries who already have entitlement to SMI and are filing for premium-HI must be input via POS. The Form CMS-18 (Application for Hospital Insurance) is normally used in this situation, however, a simple signed and dated statement such as, “I want to enroll for Part A of Medicare” is also acceptable.

Working beneficiaries age 65 or older who qualify for an SEP may apply online by visiting Medicare Part B. Under the online process for Medicare Part B SEP enrollment, beneficiaries are required to provide an eSignature to submit the forms online.

 

Working beneficiaries aged 65 or older who qualify for an SEP may apply by fax or mail by downloading and completing the:

Application for Enrollment in Medicare Part B (Medical Insurance) (CMS-40B); and

Request for Employment Information (CMS-L564). Refer to HI 00805.295 Evidence of GHP or LGHP Coverage Based on Current Employment Status for secondary proofs if the CMS-L564 cannot be provided.

The beneficiary can fax or mail these forms to their servicing FO. The address and fax numbers can be obtained by accessing Social Security Office Locator from the SSA.gov website.

If the aged beneficiary has current coverage under a GHP or the disabled beneficiary has current coverage under a LGHP based on current employment status, tell the beneficiary that:

• •

  enrollment in SMI or premium-HI may occur during any month he or she has the GHP or LGHP coverage based on current employment status; and

• •

  coverage may begin the month the enrollment application is filed, or in any of the following three months.

NOTE: If the disabled beneficiary has LGHP coverage on a basis other than current employment status, refer to HI 00805.310.

If the beneficiary is in the first month after their current employment status ends or their GHP or LGHP coverage based on current employment status ends, tell the beneficiary that:

• •

  enrollment in SMI or premium-HI may occur during the current month; and

• •

  he or she may choose coverage to begin effective with the current month or in any of the following three months.

If the beneficiary is in the second through the eighth month after their current employment status ends or their GHP or LGHP coverage based on current employment status ends, tell the beneficiary that:

• •

  enrollment in SMI or premium-HI may occur during the current month or during any of the remaining months of the SEP; and

• •

  coverage will begin the month following the month he or she files the enrollment application.

Take the following actions to process an SEP request:

1. 1. 

   Offer the beneficiary the option to have the Form CMS-40B (Application for Medicare Part B (Medical Insurance)) and Form CMS-L564 (Request for Employment Information) mailed to them or to visit Medicare.gov to get the forms by clicking on the tab “Forms, Help & Resources” and selecting “Get Medicare Forms.” This tab is located on the top of the screen at the far right. (Medicare.gov/forms-help-and-resources/forms/medicare-forms.html) This is where the beneficiary can find the forms for completion. For information on Form CMS-40B, see HI 00805.075 and for Form CMS-L564, see HI 00805.295.

2. 2. 

   If the beneficiary wants the forms mailed:

   • •

     send the forms and provide a FO return envelope; and

   • •

     Mark the top of the enrollment form with “SEP Enrollment.” If the beneficiary files while still covered under the GHP or LGHP, or during the first month after coverage or employment based on current employment status ends, make sure the Remarks section of the form CMS-40B includes the statement, “I want Part B (and Part A, if applicable) coverage to begin (MM/YY).”

3. 3. 

   Explain to the beneficiary that he or she should mail or take the completed form to their local FO for processing.

For evidence requirements for GHP or LGHP coverage, see HI 00805.295.

Example of TSC processing an SEP request for SMI:

Mr. Martin, age 68, filed for Part A of Medicare when he attained age 65. He refused SMI because he was working and covered under his employer’s group health plan. Mr. Martin decides to retire effective June 30, 2013. He wants SMI coverage effective July 2013. When Mr. Martin contacts the TSC about enrolling in SMI in April 2013, the TSC tells him that he may file an enrollment request in advance, (i.e. during April 2013, May 2013 or June 2013) and request SMI coverage effective July 2013. Mr. Martin may also wait until July 2013 to file the enrollment application for SMI coverage effective July 2013.

Mr. Martin asks to have the forms mailed to him. The TSC sends the Forms CMS-40B and CMS-L564 to Mr. Martin to complete and return to the FO. Since Mr. Martin has requested that the coverage begin July 2013, the form CMS-40B contains the statement, “I want Part B coverage to begin July 2013.”

If Mr. Martin wants coverage to begin August 2013, he may file an application for SMI as early as May 2013.

Make a claims referral per TC 24001.050D.2. On the referral, show the remarks, “SEP Enrollment”.