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4510 13th Avenue South Fargo, North Dakota 58121APPLICATION FOR DEPENDENT DISABILITY BENEFIT PLAN NUMBER Dependents Name Social Security Number Medicare ID Card Number Hospital Part A Effective Date01Medical
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How to fill out original medicare part a

01
To fill out original Medicare Part A, follow these steps:
02
Make sure you are eligible for Medicare Part A. You generally qualify if you are 65 or older and either a U.S. citizen or a permanent resident for at least 5 years.
03
If you meet the eligibility requirements, you can apply for Medicare Part A through the Social Security Administration. You can apply online, by phone, or in person at your local Social Security office.
04
Gather the necessary documents for your application, including your Social Security number, birth certificate, and proof of U.S. citizenship or lawful presence.
05
Complete the Medicare Part A application form, providing accurate and up-to-date information about your personal details, employment history, and any other requested information.
06
Submit your application to the Social Security Administration. They will process your application and notify you of your Medicare Part A enrollment status.
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Once you are enrolled in Medicare Part A, you will receive a Medicare card that you can use to access your healthcare benefits.

Who needs original medicare part a?

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Original Medicare Part A is generally needed by individuals who meet the following criteria:
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- Those who are 65 years old or older
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- U.S. citizens or permanent residents who have lived in the country for at least 5 years
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Other individuals, such as certain people with disabilities, may also qualify for Medicare Part A. It is important to review the eligibility requirements and consult with the Social Security Administration or a healthcare professional to determine if you need original Medicare Part A.
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Original Medicare Part A is hospital insurance that helps cover inpatient care in hospitals, skilled nursing facilities, hospice, and home health care.
Individuals who are eligible for Medicare benefits, including people who are 65 or older, certain younger people with disabilities, and individuals with end-stage renal disease, are required to enroll in Original Medicare Part A.
To enroll in Original Medicare Part A, eligible individuals can apply online through the Social Security Administration website, visit a local Social Security office, or call the Social Security Administration.
The purpose of Original Medicare Part A is to help cover the costs of inpatient care in hospitals, skilled nursing facilities, hospice care, and some home health care services.
Information such as the individual's name, Social Security number, birthdate, and eligibility for Medicare benefits must be reported on Original Medicare Part A.
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