Follow the steps to successfully complete your application for Part A.

1. Click ‘Get Form’ button to obtain the form and open it in the editor. This allows you to access the CMS-18-F-5 application electronically.
2. Begin with section 1, which asks for your personal information. Make sure to fill in your Social Security Number, name, date of birth, and mailing address clearly.
3. In section 2, provide details about your work history, including total earnings from last year and this year, and indicate if you worked in the railroad industry after January 1, 1937.
4. Section 3 requires you to confirm your citizenship status. Answer whether you are a U.S. citizen or lawfully present, and provide additional dates as necessary.
5. In section 4, state your marital status. Indicate whether you are currently married and provide the requested information about your spouse.
6. Section 5 is about enrollment in premium programs. Specify if you wish to apply for Part A and/or Part B, especially if premiums apply.
7. Section 6 determines your current or prior health coverage. Be prepared to answer questions regarding Medicaid and any group health plans.
8. Finally, in section 7, sign your application. Include the date and, if necessary, provide details of a witness if you cannot sign yourself.
9. Once all information is accurately filled out, review the form for completeness, then you can save changes, download, print, or share the application as required.

Complete your CMS-18-F-5 application online for a seamless experience.