Form CMS 18F5 Application for Part A (Hospital Insurance) APPLICATION FOR PART A (HOSPITAL INSURANCE 2026

1. Click ‘Get Form’ to open it in the editor.
2. In Section 1, provide your personal information. Enter your Social Security Number, name, date of birth, and contact details accurately.
3. In Section 2, detail your work history by entering your total earnings for the last year and whether you worked in the railroad industry after January 1, 1937.
4. For Section 3, indicate your citizenship status. Answer whether you are a U.S. citizen or lawfully present in the U.S., and provide relevant dates.
5. In Section 4, disclose your marital status and provide information about your spouse if applicable.
6. Section 5 requires you to confirm if you want to enroll in Part A and Part B. Make sure to select appropriately based on your premium obligations.
7. Finally, sign the application in Section 7. Ensure all required signatures are included before submitting it to your local Social Security office.

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