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CMS-40B 2021-2022 - Fill and Sign Printable Template

CMS-40B 2021-2022 - Fill and Sign Printable Template-2025

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The document is an application form for enrollment in Medicare Part B (Medical Insurance) issued by the Centers for Medicare & Medicaid Services. It requires personal information such as the applicant's Medicare number, name, address, phone number, and signature. The form also includes a section for a witness if the application is signed by mark. Additionally, it provides information regarding the estimated time to complete the form and compliance with the Paperwork Reduction Act.

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Got questions?

We have answers to the most popular questions from our customers. If you can't find an answer to your question, please contact us.

Can I apply for Medicare Plan B online?

You can complete your Medicare Part B Enrollment online. You will electronically sign the online application, so you will need to provide an email address.

What is the fastest way to get Medicare Part B?

Apply online (at Social Security) This is the easiest and fastest way to sign up and get any financial help you qualify for.

Can you apply for Medicare Part B over the phone?

If youre 65 or older, you can enroll online for Parts A and B, or Part A only. You can delay Part B if youre already covered through an employer group health plan. The application is for retirement benefits and Medicare, or Medicare only.

Can I fill out form CMS 40B online?

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).

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