Social security office form cms40b 2026

The document is a Medicare Part B enrollment application form, intended for individuals who already have Medicare Part A but wish to enroll in Part B (medical insurance). It outlines eligibility criteria, application procedures, and important deadlines such as the Initial Enrollment Period (IEP), General Enrollment Period (GEP), and Special Enrollment Periods (SEPs). The form provides instructions on how to complete the application, necessary information required, and contact details for assistance. It also includes reminders about potential late enrollment penalties.

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Click ‘Get Form’ to open it in the editor.
Enter your Medicare number in the designated field. This is essential for identifying your application.
Indicate whether you wish to enroll in Medicare Part B by marking 'Yes' if applicable. If you do not have Part A, please contact Social Security for further assistance.
Fill in your full name as registered with Social Security, including last name, first name, and middle name if applicable.
Provide your complete mailing address, including street number and name, P.O. Box, or route information.
Input your city, state, and ZIP code accurately to ensure proper correspondence.
Enter your phone number with area code for any follow-up communications.
Sign the form manually; do not print. If unable to sign, mark an 'X' and ensure a witness completes the required fields.
Date your signature appropriately to indicate when you completed the form.
If a witness is required, they must sign and provide their details as instructed on the form.

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What form do I fill out for Medicare Part B?

CMS-40B. Application for Enrollment in Medicare - Part B (Medical Insurance) CMS-L564. Request for Employment Information.

What forms do I need to fill out for Medicare Part B?

Fill out the Application for Enrollment in Medicare Part B (CMS-40B) (PDF). If you are applying during the Special Enrollment Period, also fill out the Request for Employment Information (CMS-L564) (PDF).

How do I enroll in Medicare Part B for the first time?

Most people pay the standard Part B monthly premium amount ($185 in 2025). Social Security will tell you the exact amount youll pay for Part B in 2025. You pay the standard premium amount if you: Enroll in Part B for the first time in 2025.

Can I fill out form CMS 40B online?

Call us at 1-800-772-1213, Monday through Friday, 8:00 a.m. to 7:00 p.m., with your Part B enrollment questions. To learn more about Medicares Open Enrollment Period (October 15-December 7) or if you have other Medicare questions, visit Medicare.gov or call 1-800-MEDICARE.