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Click ‘Get Form’ to open the 40b form in the editor.
Begin by entering your Social Security Claim Number and BIC at the top of the form. This information is crucial for identification purposes.
Indicate whether you wish to enroll for medical insurance under Medicare by selecting 'YES – Part B Only'.
Fill in your name, including last name, first name, and middle initial. If applicable, print the Social Security number holder's name if it differs from yours.
Provide your mailing address, ensuring accuracy for correspondence. If this is a change of address, check the designated box.
Enter your telephone number in the specified format.
Sign and date the application where indicated. If a witness is required, ensure they complete their section as well.
Review all entries for accuracy before submitting your completed form to your local Social Security office.
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Yes. If youre still getting disability benefits when you turn 65, you wont have to apply for Part B. Medicare will enroll you in Part B automatically.
What is form 40B?
You will electronically sign the online application, so you will need to provide an email address. If you prefer, you can fax or mail the completed forms CMS-40B Application for Enrollment in Medicare Part B (Medical Insurance) and CMS-L564 Request for Employment Information to your local Social Security office.
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APPLICATION FOR ENROLLMENT IN MEDICARE PART B
WHEN DO YOU USE THIS APPLICATION? Use this form: If youre in your IEP and refused Part B or did not sign up when you applied for Medicare,
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