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DEPARTMENT OF HEALTH AND HUMAN SERVICES CENTERS FOR MEDICARE & MEDICAID SERVICES Form Approved OMB No. 0938-XXXX APPLICATION FOR ENROLLMENT IN MEDICARE PART B (MEDICAL INSURANCE) WHO CAN USE THIS
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How to fill out 0938 1230

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How to fill out CMS-40B

01
Start by downloading the CMS-40B form from the official Medicare website.
02
Carefully read the instructions provided on the form.
03
Fill out your personal information in Section 1, including your name, address, date of birth, and Medicare number.
04
In Section 2, indicate your reason for applying for Medicare or making changes.
05
Provide any required documentation or additional information as requested in the form.
06
Review your completed form to ensure all information is accurate and complete.
07
Sign and date the form at the designated area.
08
Mail the completed form to the address specified on the instructions.

Who needs CMS-40B?

01
Individuals who are applying for Medicare for the first time.
02
Those who are seeking to make changes to their existing Medicare coverage.
03
People who have had changes in their circumstances affecting their eligibility for Medicare.

Who needs a CMS Form 40B?

If you are already in Medicare Part A you should apply for Medicare Part B by filing Form CMS-40B, which is actually Application for Enrollment in Medicare Part B (Medical Insurance). If you don't have Part A, the procedure of signing up for medical insurance will differ, for details you should contact your local SSA office.

And what about Medicare Part A? US citizens or residents who have lived in the US territory for five years at least) become eligible for health insurance when they turn 65, if they worked and paid into the system. Under Medicare Law, younger individuals having disabilities, end-stage renal disease or amyotrophic lateral sclerosis must be automatically enrolled in both Part A and Part B on the 25th month since the initial Social Security Disability benefit was paid.

What is the Application for Enrollment in Medicare Part B Form for?

In fact, the full name of the form speaks for itself, it is the only accepted way to apply for enrollment in Medicare Part B for individuals complying with the established requirements. This form provides all the information required by the Social Security Administration to process the request.

Is Form CMS-40B accompanied by other forms?

An applicant enrolled in Part A, but not in Part B, who wants to submit an application within a Special Enrollment Period (SEP) besides, CMS-40B should also complete and attach CMS Form L564.

When is Application for Enrollment in Medicare Part B Form due?

If you Medicare coverage hasn’t started automatically, you should consider applying in one of the three possible enrollment periods:

    Initial Enrollment Period (IEP);

    General Enrollment Period (GET);

    Special Enrollment Period (SEP);

    Let’s see what the difference is, and when each of them is applicable.

You should apply during an EIP if you refused and didn’t sign up for Part B while applying for Medicare. Initial Enrollment Period is individual and depends on applicants’ dates of birth. Generally, it lasts for seven months — three months preceding claimant's 65th birthday, the month of the 65th birthday and three months after it.

GET always has strict time limitations, it lasts from January 1st till March 31st every year.

Signing up for Plan B (and Plan A two) can be also accomplished during SEP — Special Enrollment Period. It lasts for eight months after your employment is over, or your group health plan coverage under employment ends.

How do I fill out the Application for Enrollment in Medicare Part B Form?

The filler’s fillable CMS-40B Form is a four-page document, in which the form occupies only one page and the other three are the instructions on when you get eligible for Medicare Plan B, and how to apply using CMS-40B application.

As for the form, it requires covering the following items:

    Social Security Claim Number;

    Full Name;

    Address;

    Phone Number;

    Signature and Date.

Where do I send CMS-40B Form?

The completed, dated and signed, Application for Enrollment in Medicare Part B should be submitted to the nearest SSA office in your state. The address can be found on the SSA website by your zip code.

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People Also Ask about

Call Medicare or the Social Security Administration to Check Your Application Status. You may conduct a Medicare status check over the phone by calling the Social Security Administration at 1-800-772-1213. Simply follow the automated prompts to check the status of an application or to speak with a representative.
You can apply online or you can mail your completed CMS 40B, Application for Enrollment in Medicare - Part B (Medical Insurance) to your local Social Security office.
Applications for Medicare Parts A and B can take four to eight weeks to be approved. If you apply for both at the same time, they're usually approved together. Private insurance companies offer Medicare Advantage, Medicare Part D and Medigap plans and process their own applications, so wait times may be shorter.
Generally, you're first eligible starting 3 months before you turn 65 and ending 3 months after the month you turn 65. If you don't sign up for Part B when you're first eligible, you might have to wait to sign up and go months without coverage.
To sign up for Part B in one of these situations, you'll also need to fill out and submit an Application for Enrollment in Part B (CMS-40B) form at the same time.
Fill out Form CMS-40B (Application for Enrollment in Medicare Part B). Send the completed form 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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CMS-40B is the application form used by individuals to apply for Medicare Part B (Medical Insurance).
Individuals who are eligible for Medicare Part B and wish to enroll or change their enrollment status must file CMS-40B.
To fill out CMS-40B, individuals should provide their personal information, including name, address, Medicare number, and the reason for filing the form. The instructions for the specific sections should be carefully followed.
The purpose of CMS-40B is to allow eligible individuals to apply for Medicare Part B coverage, which helps cover outpatient care, preventive services, and other medical services.
The information that must be reported on CMS-40B includes the applicant's name, Medicare number, Social Security number, address, date of birth, and the reason for applying.
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