Link: https://www.cms.gov/cms40b-application-enrollment-part-b
Description: WebThis 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
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Link: https://www.cms.gov/Medicare/CMS-Forms/CMS-Forms/Downloads/CMS40B-E.pdf
Description: WebUse this form: • If you’re in your IEP and refused Part B or did not sign up when you applied for Medicare, but now want Part B. • 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).
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Link: https://www.cms.gov/files/document/cms-40b-application-enrollment-medicare-part-b-medical-insurance.pdf
Description: WebThis 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.
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Link: https://www.ssa.gov/medicare/sign-up/part-b-only
Description: WebFill 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).
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Link: https://www.medicare.gov/basics/forms-publications-mailings/forms/enrollment
Description: WebGet the forms you need to sign up for Part B including CMS-40B, CMS-L564, CMS-10797, and CMS-10798.
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Link: https://irp.cdn-website.com/746b10ee/files/uploaded/CMS%20%20Form-40B.pdf
Description: WebThis 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). Completing this form is voluntary, but you will not be enrolled in Part B if you do not provide all of the required information.
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Link: https://www.medicare.gov/basics/get-started-with-medicare/sign-up/ready-to-sign-up-for-part-a-part-b
Description: WebFill out form CMS-40B. Send the completed form to your local Social Security office by fax or mail. Download Form. Contact Social Security to submit your forms or get help: Send completed forms to your local Social Security office by fax or mail. Call 1-800-772-1213. TTY users can call 1-800-325-0778.
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Link: https://www.ssa.gov/pubs/EN-05-10012.pdf
Description: Webcan complete and upload Form CMS-L564 (Request for Employment Information), or provide written notification (a letter, fax, or email) from the employer, GHP, or LGHP. 2. Fax your CMS-40B and employer-signed CMS-L564 (or written notification) to your local Social Security office. 3. Mail your CMS-40B and employer-signed CMS-L564 (or written ...
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Link: https://blog.ssa.gov/sign-up-for-medicare-part-b-online-by-fax-or-mail/
Description: WebAug 6, 2020 · You can complete form CMS-40B ( Application for Enrollment in Medicare – Part B [Medical Insurance]) and CMS-L564 (Request for Employment Information) online. You can also fax the CMS-40B and CMS-L564 to 1-833-914-2016; or return forms by mail to your local Social Security office .
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Link: https://www.medicare.gov/media/11873-Sign-up-Part-B-package-US.pdf
Description: WebDownloading 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. TTY users can call 1-800-325-0778.
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