Cms 40b 2025

1. Click ‘Get Form’ to open the cms 40b application in the editor.
2. In the first field, enter your Medicare Number as it appears on your Medicare card.
3. Indicate whether you wish to sign up for Medicare Part B by marking 'YES' if you want medical insurance. If not, you do not need to complete this form.
4. Fill in your full name in the format: Last Name, First Name, Middle Name. Leave the middle name blank if you do not have one.
5. Provide your complete mailing address including street number and name, P.O. Box, or route.
6. Enter your city, state, and ZIP code corresponding to your mailing address.
7. Input your phone number including area code in the designated field.
8. Sign your name in the signature section; ensure it matches how you would sign any official document.
9. Record the date of signing in the specified field.
10. If applicable, provide witness information if you signed with an 'X'.

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