Application for Enrollment in Medicare Part B (Medical Insurance) Request for Enrollment in Medicare Part B (Medical Insurance) Use this form if you already have Medicare Part A and want to sign up for Part B (Medical Insurance) You can use this form to sign up for Part B during these times:
CMS 40B | CMS Use this form if you already have Medicare Part A and want to sign up for Part B (Medical Insurance) If you don't have Part A, don't complete this application —instead, contact Social Security to apply for Medicare for the first time Submit your completed and signed form by mail, fax, or by visiting your local Social Security office in person
CMS L564 | CMS Use this form to show proof of group health plan coverage based on current employment for Medicare enrollment by completing Section A yourself and having your employer fill out Section B Submit the completed and signed form along with your Request for Enrollment in Medicare Part B (Medical Insurance) (CMS-40B) by mail or fax to your local Social Security office, which you can locate at SSA
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Request for Enrollment in Medicare Part B (Medical Insurance) Note: If you’re entitled to Social Security Railroad Board benefits use CMS-40B Request for Enrollment in Medicare Part B (Medical Insurance) You can find the application on CMS gov, or contact Social Security at 1-800-772-1213 for a copy TTY users can call 1-800-325-0778
Application for Enrollment in Medicare Part B (Medical Insurance) While you don’t have to give your information, failure to give all or part of the information requested on this form could delay your application for enrollment Social Security and CMS will use your information to enroll you in Part B
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CMS-L564: Request for Employment Information | CMS WHAT DO I DO WITH THE FORM? Fill out Section A and take the form to your employer Ask your employer to fill out Section B You need to get the completed form from your employer and include it with your Application for Enrollment in Medicare (CMS-40B) Then you send both together to your local Social Security office
CMS - L564 You need to get the completed form from your employer and include it with your Application for Enrollment in Medicare (CMS-40B) Then you send both together to your local Social Security office
Original Medicare (Part A and B) Eligibility and Enrollment This page contains information on Medicare Part A and Medicare Part B eligibility and enrollment For more information about Medicare for people who are still working, go to our Employer page or I’m 65 and Still Working page