SSA automatically enrolls beneficiaries in the following two types of cases:
1. Attainment cases
Each month the Regular Transcript Attainment and Selection Pass (RETAP) Operation
identifies records for Medicare entitlement. Four months prior to attaining age 65
and four months prior to the 25th month a beneficiary has entitlement to disability benefits, RETAP establishes hospital
insurance (HI) and supplementary medical insurance (SMI) entitlement on the master
beneficiary record (MBR) for beneficiaries who reside in the United States, the Northern
Mariana Islands, the Virgin Islands, Guam and American Samoa. RETAP establishes only
HI for beneficiaries residing in Puerto Rico or foreign countries. The Social Security
Administration (SSA) does not automatically enroll these beneficiaries in SMI. For
more information, see HI 00805.115 and HI 00805.120.
SSA sends this entitlement information to the Centers for Medicare and Medicaid Services
(CMS). CMS notifies these beneficiaries about their entitlement to HI and enrollment
in SMI via the domestic initial enrollment period (IEP) package. CMS mails the domestic
IEP package three months prior to the beneficiary’s age 65-attainment month or three
months prior to the 25th month of disability benefit entitlement.
The domestic IEP package contains:
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Welcome to Medicare letter;
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Welcome to Medicare booklet that provides an overview of the Medicare Program;
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Form CMS-40/CMS-1966 (Medicare card/SMI Refusal card) which is the beneficiary’s Medicare
card showing the effective dates of HI and SMI entitlement (on the front) and the
SMI refusal form (on the back); and
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Return envelope to mail SMI refusals to the processing center (PC) of jurisdiction.
If we automatically enroll a beneficiary in SMI, the beneficiary has the opportunity
to refuse coverage. If the beneficiary does not want SMI coverage, the beneficiary
should follow the instructions on the Medicare card and in the Welcome to Medicare
booklet to check the appropriate box on the card, sign, and return the card in the
enclosed envelope before the effective date. Once we process the SMI refusal, CMS
issues a new Medicare card showing the HI entitlement date only. Beneficiaries will
receive the revised cards about four weeks after we process the refusal.
For a detailed description of the domestic IEP package, see HI 00805.125B.
2. New entitlement cases
For new entitlement cases, automatic enrollment in SMI occurs when we process an application
for disability benefits and establish HI entitlement during or after the individual’s
IEP.
We enroll (deem) these beneficiaries in SMI and establish the SMI entitlement in the
MBR. They do not receive an IEP package. We provide information about HI and SMI entitlement
in the SSA award notice. Each beneficiary automatically enrolled in SMI has until
a specified date (at least two calendar months after the month in which we mail the
notice of SMI coverage) to refuse SMI. For information about refusing SMI enrollment,
see HI 00805.055.
Beneficiaries receive their Medicare cards approximately four weeks after we establish
the Medicare entitlement. The card shows the effective dates of entitlement to HI
and SMI. If the beneficiary refuses SMI, SSA processes the refusal, and CMS issues
a new Medicare card showing the HI entitlement date only. Beneficiaries will receive
the revised cards about four weeks after we process the refusal.