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• If you want to sign up for Part B during the General Enrollment Period (GEP) from January 1 – March 31 each year. • If you’re eligible for a Special Enrollment Period (SEP). • If you’re in your . Initial Enrollment Period (IEP) and live in. Puerto Rico. You must sign up for Part B using this form. NOTE: Your IEP lasts for 7 months.
Get the forms you need to sign up for Part B including CMS-40B, CMS-L564, CMS-10797, and CMS-10798.
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
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).
SPECIAL MESSAGE FOR INDIVIDUAL APPLYING FOR 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
Downloading Form CMS-40B (Application for Enrollment in Medicare Part B) at Medicare.gov/basics/forms-publications-mailings/forms/enrollment. Complete the application and sign it. Return the completed application to your local Social Security ofice. Calling Social Security at 1-800-772-1213.
Part B helps cover medically necessary services like doctors’ services, outpatient care, and other medical services that Part A doesn’t cover. Part B also covers many preventive services. Part B coverage is your choice. However, you need to have Part B if you want to buy Part A.
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