You must be logged in to bookmark pages. Most people become eligible for Medicare when they turn 65. Your Medicare enrollment steps will differ depending on whether or not you are collecting retirement benefits when you enter your
Initial Enrollment Period (IEP). If you are eligible for
automatic enrollment, you should not have to contact anyone. You should receive a package in the mail three months before your coverage starts with your new Medicare card. There will
also be a letter explaining how Medicare works and that you were automatically enrolled in both Parts A and B. If you get Social Security retirement benefits, your package and card will come from the Social Security Administration (SSA). If you get Railroad Retirement benefits, your package and card will come from the Railroad
Retirement Board. Typically, you should not turn down Part B unless you have insurance based on your or your spouse’s current work
(job-based insurance). If you do not have job-based insurance and you turn down Part B, you may incur a premium penalty if you need to sign up for Medicare
coverage in the future. Also, if your job-based insurance will pay secondary after you become eligible for Medicare, you should consider enrolling in Medicare in order to have primary coverage and pay less for your care. If you are 65 but are not receiving Social Security retirement benefits
or Railroad Retirement benefits, you will need to actively enroll in Medicare. Follow the steps below if you need to actively enroll in Medicare. If you decide to enroll in Medicare during your Initial Enrollment Period, you can sign up for Parts A and/or B by: If you are eligible for Railroad Retirement benefits, enroll in Medicare by calling the Railroad Retirement Board (RRB) or contacting your local RRB field office. Keep proof of when you tried to enroll in Medicare, to protect yourself from incurring a Part B premium penalty if your application is lost. Generally, we advise people to file for Medicare benefits 3 months before age 65. Remember, Medicare benefits can begin no earlier than age 65. If you are already receiving Social Security, you will automatically be enrolled in Medicare Parts A and B without an additional application. However, because you must pay a premium for Part
B coverage, you have the option of turning it down. You will receive a Medicare card about two months before age 65. (Note: Residents of Puerto Rico or foreign countries will not receive Part B automatically. They must elect this benefit.) If you would like to file for Medicare only, you can apply by calling 1-800-772-1213. Our representatives there can make an appointment for you at any convenient Social Security office and advise you what to bring with you.
When you apply for Medicare, we often also take an application for monthly benefits. You can apply for retirement benefits online. If you didn’t sign up when you were first eligible for Medicare, you can sign up during the General Enrollment Period between January 1 and March 31 each year, unless you are eligible for a
Special Enrollment Period. Content created by Digital Communications Division (DCD) APPLICATION FOR ENROLLMENT IN MEDICARE PART B (MEDICAL INSURANCE)WHO CAN USE THIS APPLICATION?People with Medicare who have Part A but not Part B WHEN DO YOU USE THIS APPLICATION?Use this form:
NOTE: Your IEP lasts for 7 months. It begins 3 months before your 65th birthday (or 25th month of disability) and ends 3 months after you reach 65 (or 3 months after the 25th month of disability). WHAT INFORMATION DO YOU NEED TO COMPLETE THIS APPLICATION?You will need:
WHAT HAPPENS NEXT?Send your completed and signed application to your local Social Security office. If you sign up in a SEP, include the CMS-L564 with your Part B application. If you have questions, call Social Security at 1-800-772-1213. TTY users should call 1-800-325-0778. HOW DO YOU GET HELP WITH THIS APPLICATION?
REMINDERS
You have the right to get Medicare information in an accessible format, like large print, Braille, or audio. You also have the right to file a complaint if you feel you’ve been discriminated against. Visit https://www.medicare.gov/about-us/accessibilitynondiscrimination-notice, or call 1-800-MEDICARE (1-800-633-4227) for more information. TTY users can call 1-877-486-2048. CMS-40B (04/19) DEPARTMENT OF HEALTH AND HUMAN SERVICES Form Approved APPLICATION FOR ENROLLMENT IN MEDICARE PART B (MEDICAL INSURANCE)2. Do you wish to sign up for Medicare Part B (Medical Insurance)? YES 3. Your Name (Last Name, First Name, Middle Name) 4. Mailing Address (Number and Street, P.O. Box, or Route) 6. Phone Number (including area code) () - 7. Written Signature (DO NOT PRINT) IF THIS APPLICATION HAS BEEN SIGNED BY MARK (X), A WITNESS WHO KNOWS THE APPLICANT 12. Remarks According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unless it displays a valid OMB control number. The valid OMB control number for this information collection is 0938-1230. The time required to complete this information is estimated to average 15 minutes per response, including the time to review instructions, search existing data resources, gather the data needed, and complete and review the information collection. If you have any comments concerning the accuracy of the time estimate(s) or suggestions for improving this form, please write to: CMS, Attn: PRA Reports Clearance Officer, 7500 Security Boulevard, Baltimore, Maryland 21244-1850. CMS-40B (04/19)Note: Download your information to PDF before printing. Form Approved SPECIAL MESSAGE FOR INDIVIDUAL APPLYING FOR PART BThis form is your application for Medicare Part B (Medical Insurance). You can use this form to sign up for Part B:
Initial Enrollment PeriodYour IEP is the first chance you have to sign up for Part B.It lasts for 7 months. It begins 3 months before the month you reach 65, and it ends 3 months after you reach 65. If you have Medicare due to disability, your IEP begins 3 months before the 25th month of getting Social Security Disability benefits, and it ends 3 months after the 25th month of getting Social Security Disability benefits. To have Part B coverage start the month you’re 65 (or the 25th month of disability insurance benefits); you must sign up in the first 3 months of your IEP. If you sign up n any of the remaining 4 months, your Part B coverage will start later. General Enrollment PeriodIf you don’t sign up for Part B during your IEP, you can sign up during the GEP. The GEP runs from January 1 through March 31 of each year. If you sign up during a GEP, your Part B coverage begins July 1 of that year. You may have to pay a late enrollment penalty if you sign up during the GEP. The cost of your Part B premium will go up 10% for each 12-month period that you could have had Part B but didn’t sign up. You may have to pay this late enrollment penalty aslong as you have Part B coverage. Special Enrollment PeriodIf you don’t sign up for Part B during your IEP, you cansign up without a late enrollment penalty during a SpecialEnrollment Period (SEP). If you think that you may be eligible for a SEP, please contact Social Security at 1-800-772-1213. TTY users should call 1-800-325-0778 You can use a SEP when your IEP has ended. The most common SEPs apply to the working aged, disabled, and international volunteers. Working Aged/Disabled
You can sign up for Part B anytime while you have a GHP coverage based on current employment or during the 8 months after either the coverage ends or the employment ends, whichever happens first. If you sign up while you have GHP coverage based on current employment, or, during the first full month that you no longer have this coverage, your Part B coverage will begin the first day of the month you sign up. You can also choose to have your coverage begin with any of the following 3 months. If you sign up during any of the remaining 7 months of your SEP, your Part B coverage will begin the month after you sign up. NOTE: COBRA coverage or a retiree health plan is not considered group health plan coverage based on current employment. International Volunteers PRIVACY ACT STATEMENT: 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. 1395o, 1395s, and 1395ii) for your enrollment in Medicare Part B. Social Security and the Centers for Medicare & Medicaid Services (CMS) need your information to
determine if you’re entitled to Part B. Form Approved STEP BY STEP INSTRUCTIONS FOR FILLING OUT THIS APPLICATION
IMPORTANT INFORMATION: If you’re signing up for Part B using a Special Enrollment Period (SEP) because you were covered under a group health plan based on current employment, in addition to this application, you will also need to have your employer fill out and return the “Request for Employment Information” form (CMS-L564/CMS-R-297) with your application. The purpose of this form is to provide documentation to Social Security that proves that you have been continuously covered by a group health plan based on current employment, with no more than 8 consecutive months of not having coverage. If your employer went out of business or refuses to complete the form, please contact Social Security about other information you may be able to provide to process your SEP enrollment request. Send the application (and the “Request for Employment Information,” if applicable) to your local Social Security Office. Find your local office at www.ssa.gov. INSTRUCTIONS: CMS-40B (04/19) What is the easiest way to sign up for Medicare?Apply online (at Social Security) – This is the easiest and fastest way to sign up and get any financial help you may need. You'll need to create your secure my Social Security account to sign up for Medicare or apply for Social Security benefits online. Call 1-800-772-1213. TTY users can call 1-800-325-0778.
How do I sign up for Medicare if I already get Social Security?If you already get Social Security benefits, you do not need to sign up for Medicare. We will automatically enroll you in Original Medicare (Part A and Part B) when you become eligible.
How do I enroll in Medicare Part B for the first time?Medicare will enroll you in Part B automatically. Your Medicare card will be mailed to you about 3 months before your 65th birthday. If you're not getting disability benefits and Medicare when you turn 65, you'll need to call or visit your local Social Security office, or call Social Security at 1-800-772-1213.
How do I sign up for Medicare automatically?If you're enrolled in Original Medicare (Parts A and B) or a Medicare Advantage (MA) plan, your plan will renew automatically.. 3 months before the month you turn 65.. The month you turn 65.. 3 months after the month you turn 65.. |