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  2. CMS40B - Application for Enrollment in Part B | CMS

    www.cms.gov/cms40b-application-enrollment-part-b

    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.

  3. Application for Enrollment in Medicare Part B (Medical Insurance)

    www.cms.gov/Medicare/CMS-Forms/CMS-Forms/Downloads/CMS40B-E.pdf

    You must sign up for Part B using this form. NOTE: Your IEP lasts for 7 months. It begins 3 months before your 65th birthday (or 25th month of disability) and ends 3 months after you reach 65 (or 3 months after the 25th month of disability).

  4. Application for Enrollment in Medicare Part B (Medical Insurance)

    www.cms.gov/files/document/cms-40b-application-enrollment-medicare-part-b...

    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.

  5. CMS 40B | CMS - Centers for Medicare & Medicaid Services

    www.cms.gov/Medicare/CMS-Forms/CMS-Forms/CMS-Forms-Items/CMS017339

    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.

  6. CMS-L564: Request for Employment Information | CMS

    www.cms.gov/cms-l564-request-employment-information

    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 .

  7. REQUEST FOR EMPLOYMENT INFORMATION - Centers for Medicare &...

    www.cms.gov/Medicare/CMS-Forms/CMS-Forms/Downloads/CMS-L564E.PDF

    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. Find your local office here: www.ssa.gov. GET HELP WITH THIS FORM.

  8. CMS Forms List | CMS - Centers for Medicare & Medicaid Services

    www.cms.gov/medicare/forms-notices/cms-forms-list

    CMS Forms List. The following provides access and/or information for many CMS forms. You may also use the "Search" feature to more quickly locate information for a specific form number or form title. Showing 1 – 10 of 167 entries.

  9. REQUEST FOR ENROLLMENT IN SUPPLEMENTARY MEDICAL INSURANCE

    www.cms.gov/Medicare/CMS-Forms/CMS-Forms/Downloads/CMS4040-ENGLISH.pdf

    This form is your application for Medicare Part B (Medical Insurance). You can use this form to sign up: • During your Initial Enrollment Period (IEP) when you’re first eligible for Medicare.

  10. FORM CMS 1763, REQUEST FOR TERMINATION OF PREMIUM PART A, PART B,...

    www.cms.gov/Medicare/CMS-Forms/CMS-Forms/Downloads/CMS1763.pdf

    The completion of this form is needed to document your voluntary request for termination of Medicare coverage as permitted under the Code of Federal Regulations. Section 1838(b) and 1818A(c)(2)(B) of the Social Security Act require filing of notice advising the Administration when termination of Medicare coverage is requested.

  11. SOLICITUD DE INSCRIPCIƓN EN LA PARTE B DE MEDICARE (SEGURO...

    www.cms.gov/Medicare/CMS-Forms/CMS-Forms/Downloads/CMS40B-S.pdf

    Utilice este formulario: • Si se encuentra en su IEP y rechazó la Parte B o no se inscribió cuando solicitó Medicare, pero ahora quiere la Parte B. • Si desea inscribirse en la Parte B durante el Período de Inscripción General (GEP) del 1 de enero al 31 de marzo de cada año.