[Code of Federal Regulations]

[Title 42, Volume 2]

[Revised as of October 1, 2005]

From the U.S. Government Printing Office via GPO Access

[CITE: 42CFR406.7]



[Page 248-249]

 

                         TITLE 42--PUBLIC HEALTH

 

                    CHAPTER IV--CENTERS FOR MEDICARE

                          & MEDICAID SERVICES,

                        DEPARTMENT OF HEALTH AND

                             HUMAN SERVICES

 

PART 406_HOSPITAL INSURANCE ELIGIBILITY AND ENTITLEMENT--Table of Contents

 

                      Subpart A_General Provisions

 

Sec. 406.7  Forms to apply for entitlement under Medicare Part A.



    The following forms, available free of charge by mail from CMS or at 

any Social Security branch or district office, are used to apply for 

Medicare entitlement under the circumstances indicated:



    CMS-18-F-5--Application for Hospital Insurance Entitlement. (For use 

by individuals who are not eligible for retirement benefits under Title 

II of the Social Security Act or under the Railroad Retirement Act. This 

form may also be used for enrollment in the supplementary medical 

insurance program.)



[[Page 249]]



    CMS-43--Application for Health Insurance Benefits under Medicare for 

Individuals with End Stage Renal Disease (ESRD). (An initial application 

for entitlement by individuals with ESRD).





As an alternative, an individual may use the application for monthly 

social benefits to apply also for Medicare entitlement if he or she is 

eligible for hospital insurance at that time.



[53 FR 6633, Mar. 2, 1988]