Social Security Medicare Part B Application Form

This information is needed for ssa and the centers for medicare medicaid services cms to determine if you are entitled to supplementary medical insurance part b.

Social security medicare part b application form.

Call us at 1 800 772 1213 tty 1 800 325 0778. Or contact your local social security office. You can also fax your enrollment forms and evidence of employment to 1 833 914 2016. You will need to sign up for it during your initial enrollment period or you will pay a penalty.

You may complete the forms online by visiting the apply for medicare part b online during a special enrollment period webpage. If you worked for a railroad call the rrb at 1 877 772 5772. State i want part b coverage to begin mm yy in the remarks section of the cms 40b form or the online application. Please call us at 1 800 772 1213 tty 1 800 325 0778 monday through friday between 8 a m.

An appointment is not. 1395o 1395s and 1395ii for your enrollment in medicare part b. 1395o 1395s and 1395ii. If you already have part a and want to sign up for part b complete an application for enrollment in part b cms 40b.

Get this form and instructions in spanish. Many forms must be completed only by a social security representative. The form you are looking for is not available online. If you don t already have part a you can apply online at ssa gov benefits medicare.

Social security and the centers for medicare medicaid services cms need your information to determine if you. To sign up please call our toll free number at 1 800 772 1213 tty 1 800 325 0778 you also may contact your local social security office. Social security is authorized to collect your information under sections 1836 1840 and 1872 of the social security act as amended 42 u s c. Social security is authorized to collect your information under sections 1836 1840 and 1872 of the social security act as amended 42 u s c.

Fax them to 1 833 914 2016. You can complete an application for retirement spouse s medicare or disability benefits online. Or return the forms by mail to your local social security office. Visit your local social security office.

Visit faq ssa gov or call social security to free at 1 800 772 1213 tty 1 800 325 0778 for more information. Call social security at 1 800 772 1213 tty. If you do not wish to use the online application or the application for the benefit you want is not available online you can. When do i sign up.

If you don t already have part a you can apply online at ssa gov benefits medicare. Visit faq ssa gov or call social security toll free at 1 800 772 1213 for more information. If you have questions please contact social security at 1 800 772 1213 tty 1 800 325 0778.