TN 25 (09-93)

A. Procedure— Initial interview

When an individual age 64 years and 9 months or older contacts SSA to file for Medicare, ascertain whether the individual wishes to file for both monthly benefits and HI, or for HI only. If, after you make the appropriate explanations, you determine that it is advantageous not to establish RSI benefit entitlement, inform the claimant that he/she can file for HI only.

If there is any doubt about whether it is advantageous to file for monthly benefits, advise the claimant to file since the monthly benefit portion of the application can always be withdrawn later should such action prove to be advantageous.

B. Procedure — HI only claim

1. General

If a person wishes to file for HI only, have the person (or the person's representative) file the same application he/she would file if filing for the monthly benefit on which HI eligibility is based. Where a paper application is required:

• Change the title of the application to “Application for Hospital Insurance.”

• Delete that portion of the heading which states that the application is an application for title II benefits.

• Add to the “Remarks” section the following statement: “I understand this application will be effective for Medicare entitlement only. I also understand that I must file a separate application when I wish to establish entitlement to monthly social security benefits.”

• Have the applicant complete only those items on the application which relate to eligibility for monthly title II benefits (i.e., do not have the applicant complete items such as those relating to non-service months).

2. Filing by NH

Obtain proof of age and verify that the individual is insured for RIB.

3. Filing by auxiliary

If the NH is not filing for monthly benefits for him/herself, obtain proof-of-age and evidence of insured status for the NH. Also, if the NH is under age 62 and eligible for, but not entitled to DIB, obtain evidence of disability.

For the applicant, obtain proof-of-age and insured status and, as appropriate, evidence of relationship, dependency, support, and disability (in the unusual case where claimant is 65 or over and eligible for CDB).

4. Filing by survivor

For the NH, obtain proof of death and evidence of insured status.

For the applicant, obtain proof-of-age and insured status and, as appropriate, evidence of relationship, dependency, support, and disability.

C. References

• GN 00204.009 Abbreviated Applications — Title II

• GN 00204.021 Separate HI Filing