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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 you’re first eligible for Medicare. During the General Enrollment Period (GEP) from January 1 through March 31 of each year.
Medicare Premium Part A or Part B during your IEP, GEP, or a SEP, you can sign up during a SEP for Exceptional Conditions. If you think that you may be eligible for a SEP for Exceptional Conditions, please complete the form CMS 10797 (Application for Medicare Part A and Part B Special Enrollment Period (Exceptional Circumstances)). Visit . cms.
APPLICATION FOR MEDICARE PART A AND PART B – SPECIAL ENROLLMENT PERIOD (EXCEPTIONAL CONDITIONS) WHAT IS THE PURPOSE OF THIS FORM? If, due to an exceptional condition, you didn’t sign up for Medicare Premium Part A or Part B during your Initial Enrollment Period (IEP), General Enrollment Period (GEP), or a Special Enrollment Period (SEP) you ...
CMS-40B: Individuals who have Part A, but not Part B, should complete form CMS-40B to enroll in Part B. If applying for the SEP for the Working aged and Working Disabled, also complete the form CMS-L564.
Application for Medicare Part A & Part B Special Enrollment Period (Exceptional Conditions)
To join a Medicare Advantage or Medicare drug plan, the person must be enrolled in Part A and/or Part B, depending on the type of plan they want to join. Formerly incarcerated beneficiaries must ensure they meet all general eligibility requirements before they can join a plan.
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.
NOTE: Because you’re signing up for Part A, you can also sign up for Part B (Medical Insurance) with this form. Part B covers doctors’ services and more. WHAT INFORMATION DO YOU NEED TO COMPLETE THIS APPLICATION? You will need your • Social Security Number • Date of birth • Current address and phone number • Work history
PART B IMMUNOSUPPRESSIVE DRUG COVERAGE. WHO CAN USE THIS FORM? People with Medicare premium Part A or B who would like to terminate their hospital or medical insurance coverage. WHEN DO YOU USE THIS APPLICATION? Use this form: • If you have premium Part A or Part B, but wish to no longer be enrolled. • If you have Part B, but recently re ...
Starting on February 15, 2021 and continuing through May 15, 2021, Marketplaces using the HealthCare.gov platform will operationalize functionality to make a SEP available to all Marketplace-eligible consumers who are submitting a new application or updating an existing application.