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Last updated: 8/16/2023
Application For Part A (Hospital Insurance) {CMS-18-F-5}
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Description
CMS-18-F-5 - APPLICATION FOR PART A (HOSPITAL INSURANCE). This form is for people age 65 and older (and those turning 65 in the next 3 months) who want to apply for Part A. Part A covers hospital care and more. Use this form: • If you're eligible for Social Security benefits but only want to get Medicare. You must at least 64 and 8 months. (You won't pay a premium for Part A.) • If you're not eligible for Social Security benefits and want to sign up for Part A. You can sign up only during certain times— see next page. (You'll pay a premium for Part A.) NOTE: Because you're signing up for Part A, you can also sign up for Part B (Medical Insurance) with this form. Part B covers doctors' services and more. The form collects personal, work, citizenship, marital, and health coverage information to determine eligibility and premiums. Applicants can also choose to enroll in Part B (Medical Insurance). The form includes instructions and sections for providing necessary details. www.FormsWorkflow.com
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