Skip to main content Skip to footer site map

FormsStaffBenefits → Acknowledgement of Medicare Enrollment Requirements for All Disability Retirees

Acknowledgement of Medicare Enrollment Requirements for All Disability Retirees

About this Form

Form number: 455-14

Audience:  MCPS Retirees

Last revised: November 2011

Montgomery County Public Schools (MCPS) requires all participants (both retirees and dependents) in the MCPS retiree benefit plan to enroll in Medicare Parts A and B when first eligible for Medicare in order to maintain medical health benefits through the MCPS retiree benefit plan. As a disability retiree, there are special enrollment eligibility rules that apply.

Individuals meeting any one of the following criteria are eligible for and must enroll in Medicare when first eligible:

  • All retirees who are age 65 and over
  • Retirees who receive disability benefits from the Social Security Administration and are beginning the twenty-fifth month of their entitlement
  • Retirees who have end-stage renal disease
Adobe PDF Acknowledgement of Medicare Enrollment Requirements for All Disability Retirees32 KEnglish

Forms require Adobe Acrobat Reader 8 or higher. Get Acrobat

Click here to log in