Parte b 2026

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

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