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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.
You can complete the Part B SEP online or you can mail your completed CMS 40B, Application for Enrollment in Medicare - Part B (Medical Insurance) and CMS L564 - Request for Employment Information to your local Social Security office.
Phone: Call Social Security at 1-800-772-1213. En espaol: Llame a SSA gratis al 1-800-772-1213 y oprima el 2 si desea el servicio en espaol y espere a que le atienda un agente. In person: Your local Social Security office. For an office near you check .ssa.gov.
The Centers for Medicare Medicaid Services (CMS) is a Federal agency within the U.S. Department of Health and Human Services. Many CMS program related forms are available in Portable Document Format (pdf).
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