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The document is an application form for enrollment in Medicare's Medical Insurance program, specifically for Part B coverage. It outlines the necessary personal information required from the applicant, including their Social Security number, mailing address, and signature. The form provides details on enrollment periods, eligibility criteria, and potential penalties for late enrollment. It emphasizes the importance of submitting the completed form to the local Social Security office and includes privacy notices regarding the use of personal information.

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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?

Can I submit my Medicare Part B application online?

Apply online (at Social Security) \u2013 This is the easiest and fastest way to sign up and get any financial help you may need. You'll need to create your secure my Social Security account to sign up for Medicare or apply for Social Security benefits online. Call 1-800-772-1213. TTY users can call 1-800-325-0778.

How do I get a CMS-L564 form?

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.

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.

social security form 40b

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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 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.

What is a CMS 40B form?

CMS 40B. Form Title. Application for Enrollment in Medicare - Part B (Medical Insurance) Revision Date.

Is Medicare Part B based on income?

If your modified adjusted gross income as reported on your IRS tax return from 2 years ago is above a certain amount, youll pay the standard Part B premium and an income-related monthly adjustment amount.

How to submit CMS 40B and CMS L564?

Fill out Section A and take the form to your employer. Ask your employer to fill out Section B. 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.

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