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  1. www.cms.gov › cms40b-application-enrollment-part-bCMS40B - Application for Enrollment in Part B | CMS

    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

  2. www.medicare.gov › basics › forms-publications-mailingsEnrollment Forms - Medicare

    Get the forms you need to sign up for Part B including CMS-40B, CMS-L564, CMS-10797, and CMS-10798.

  3. www.cms.gov › Medicare › CMS-FormsCMS 40B | CMS - Centers for Medicare & Medicaid Services

    10 sty 2024 · 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. You’ll also need to send CMS L564 - Request for Employment Information, and a required proof of employment, Group Health Plan (GHP), or Large Group Health Plan (LGHP) coverage ...

  4. medicarehbs.com › wp-content › uploadsCMS - 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.

  5. www.ssa.gov › medicare › sign-upSign up for Part B only | SSA

    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).

  6. www.ssa.gov › pubs › EN-05-10012EN-05-10012- How to Apply for Medicare Part B During Your Special...

    Go to “Apply Online for Medicare Part B During a Special Enrollment Period” and complete CMS-40B and CMS-L564. Then, upload your evidence of Group Health Plan (GHP) or Large Group Health Plan (LGHP) coverage based on current employment.

  7. medicareschool.com › how-to-fill-out-medicare-forms-cms-l564-and-cms-40-bHow to Fill Out Medicare Forms CMS-L564 and CMS 40-b

    How to Fill Out Medicare Form CMS-40b. The CMS-40b is a simple form indicating when you want to start your Medicare Part B coverage. It should only take about one minute to complete. First, you’ll need to provide your Medicare number.