Under the provisions of title XVIII as originally enacted, an individual eligible for SMI had to take the positive action of filing a written request for enrollment. While most individuals did enroll, some persons who wanted SMI failed to enroll at their first opportunity because of senility, misunderstanding, or other reasons.

Since the enrollment provisions are so strict, many incurred medical expenses before they had the opportunity to enroll again.

To avoid loss of coverage, the law was amended effective 7/1/73 to provide that eligible persons are “automatically” enrolled for SMI when they first become entitled to HI.

As part of the notice of automatic enrollment, individuals are informed of their right to decline SMI and given a reasonable period to notify SSA that they do not want SMI.

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  Automatic enrollment is not applicable, HI 00805.050.

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  Notice of the right to refuse SMI, HI 00805.055.