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The document is an application form for enrollment in Medicare Part B (Medical Insurance) provided by the Department of Health and Human Services. It outlines who can use the application, the process for signing up during different enrollment periods (Initial Enrollment Period, General Enrollment Period, and Special Enrollment Period), and the necessary information required to complete the application. It also includes instructions for submitting the form and contact information for assistance.

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Can I fill out form CMS 40B online?

This form is your application for Medicare Part B (Medical Insurance). You can use this form to sign up for Part B: During your Initial Enrollment Period (IEP) when youre first eligible for Medicare. During the General Enrollment Period (GEP) from January 1 through March 31 of each year.

What form do I fill out for Medicare Part B?

You can complete your Medicare Part B Enrollment online. You will electronically sign the online application, so you will need to provide an email address.

Can you apply for Medicare Part B over the phone?

If youre 65 or older, you can enroll online for Parts A and B, or Part A only. You can delay Part B if youre already covered through an employer group health plan. The application is for retirement benefits and Medicare, or Medicare only.