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The document is an application form for enrollment in Medicare Part B (Medical Insurance) provided by the Centers for Medicare & Medicaid Services. It outlines who can use the application, the process for signing up during different enrollment periods (Initial Enrollment Period, General Enrollment Period, and Special Enrollment Period), and the necessary information required to complete the application. It also includes instructions for submitting the form and contact information for assistance.

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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.

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.

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.

What is CMS 40B form?

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

What are the latest CMS forms?

CMS Forms List Form #Form TitleRevision Date Form # CMS 179 Form Title TRANSMITTAL AND NOTICE OF APPROVAL OF STATE PLAN MATERIAL Revision Date 2024-01-01 Form # CMS 18-F-5 Form Title APPLICATION FOR PART A (HOSPITAL INSURANCE) Revision Date 2023-06-30112 more rows

cms 40b form 2021

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Where do I get form CMS 40B?

In person: Your local Social Security office. For an office near you check .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.

What is cms40b?

This form is your application for Medicare Part B (Medical Insurance). You can use this form to sign up for Part B: During your Initial Enrollment Period (IEP) when youre first eligible for Medicare. During the General Enrollment Period (GEP) from January 1 through March 31 of each year.

Can Medicare Part B be done online?

You can apply online when youre ending an employer group health plan. During this Special Enrollment Period, you can apply any time of year.

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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