Social Security Medicare Part B Application Form

If you live in puerto rico you will not receive medicare part b medical insurance automatically.

Social security medicare part b application form.

If you already have part a and want to sign up for part b complete an application for enrollment in part b cms 40b. 1395o 1395s and 1395ii. Or return the forms by mail to your local social security office. Visit faq ssa gov or call social security to free at 1 800 772 1213 tty 1 800 325 0778 for more information.

Social security is authorized to collect your information under sections 1836 1840 and 1872 of the social security act as amended 42 u s c. Visit your local social security office. This information is needed for ssa and the centers for medicare medicaid services cms to determine if you are entitled to supplementary medical insurance part b. Call us at 1 800 772 1213 tty 1 800 325 0778.

You will need to sign up for it during your initial enrollment period or you will pay a penalty. 1395o 1395s and 1395ii for your enrollment in medicare part b. Fax them to 1 833 914 2016. Or contact your local social security office.

You can complete an application for retirement spouse s medicare or disability benefits online. You can also fax your enrollment forms and evidence of employment to 1 833 914 2016. Please call us at 1 800 772 1213 tty 1 800 325 0778 monday through friday between 8 a m. Many forms must be completed only by a social security representative.

If you worked for a railroad call the rrb at 1 877 772 5772. Call social security at 1 800 772 1213 tty. When do i sign up. If you don t already have part a you can apply online at ssa gov benefits medicare.

You may complete the forms online by visiting the apply for medicare part b online during a special enrollment period webpage. If you have questions please contact social security at 1 800 772 1213 tty 1 800 325 0778. Social security and the centers for medicare medicaid services cms need your information to determine if you. Social security is authorized to collect your information under sections 1836 1840 and 1872 of the social security act as amended 42 u s c.

State i want part b coverage to begin mm yy in the remarks section of the cms 40b form or the online application. To sign up please call our toll free number at 1 800 772 1213 tty 1 800 325 0778 you also may contact your local social security office. 1395o 1395s and 1395ii for your enrollment in medicare part b. Get this form and instructions in spanish.

The form you are looking for is not available online. An appointment is not. The social security act as amended 42 u s c.