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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. Find your local office here: www.ssa.gov.
Where do I fax CMS-L564?
You can also fax the CMS-40B and CMS-L564 to 1-833-914-2016; or return forms by mail to your local Social Security office.
How do I submit Medicare Part B?
Fill out Form CMS-40B (Application for Enrollment in Medicare Part B). Send the completed form to your local Social Security office by fax or mail. Call 1-800-772-1213. TTY users can call 1-800-325-0778.
Where do I send my CMS 40B?
Send your completed and signed application to your local Social Security office. If you sign up in a SEP, include the CMS-L564 with your Part B application. If you have questions, call Social Security at 1-800-772-1213. TTY users should call 1-800-325-0778.
Where do I send my CMS 40B?
Send your completed and signed application to your local Social Security office. If you sign up in a SEP, include the CMS-L564 with your Part B application. If you have questions, call Social Security at 1-800-772-1213. TTY users should call 1-800-325-0778.
cms40b form
cms40b formcms-40b form 2022cms-40b form 2021cms-l564medicare formscms.gov formsmedicare application form pdfcms-l564 form download
Fill out Form CMS-40B (Application for Enrollment in Medicare Part B). Send the completed form to your local Social Security office by fax or mail. Call 1-800-772-1213. TTY users can call 1-800-325-0778.
What is CMS 40B form?
CMS 40B. Form Title. Application for Enrollment in Medicare - Part B (Medical Insurance) Revision Date.
Can I fill out form CMS 40B online?
You can apply online or you can mail your completed CMS 40B, Application for Enrollment in Medicare - Part B (Medical Insurance) to your local Social Security office.
cms40b medicare form
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Sign up for Medicare Part B Online, by Fax or Mail
Aug 6, 2020 — You can complete form CMS-40B (Application for Enrollment in Medicare – Part B [Medical Insurance]) and CMS-L564 (Request for Employment ...
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