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The CMS-855R (Reassignment of Medicare Benefits) form has been discontinued. For additional information regarding the Medicare enrollment process (including Internet-based PECOS) and to get the current version of the CMS-855I, go to CMS.gov/Medicare/Provider-Enrollment-and-Certification.
They must: File an application to enroll by contacting the Social Security Administration; Enroll during a valid enrollment period; and. Also enroll in or already have Part B. To keep premium Part A, the person must continue to pay all monthly premiums and stay enrolled in Part B.
Get the forms you need to sign up for Part B including CMS-40B, CMS-L564, CMS-10797, and CMS-10798.
Enrollment - Completing paper Medicare enrollment applications. 1. Am I required to designate a contact person on the enrollment application? No. However, designating a contact person with whom Medicare can speak regarding information on the application will expedite the processing of the enrollment.
18 kwi 2024 · What Documents Do I Need to Apply for Medicare? Required documents. Other documents. Replacing lost documents. Where to enroll. Takeaway. To enroll in Medicare, you need to prove your...
For additional information regarding the Medicare enrollment and reassignment process, including Internet-based PECOS and to get the current version of the CMS-855R, go to . http://www.cms.gov/MedicareProviderSupEnroll. INSTRUCTIONS FOR COMPLETING THIS APPLICATION
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) .
