CMS-40B free printable template

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

How to fill out 0938 1230 form

How to fill out 0938 1230:

1. Start by gathering all the necessary information required for this form.
2. Carefully read the instructions provided with the form to understand the specific requirements and guidelines.
3. Begin by writing your personal information, such as your name, address, and contact details, in the designated fields.
4. Fill in any additional details or sections as required by the form. This may include providing information about your employment, income, or any relevant personal circumstances.
5. Double-check all the information you have entered to ensure accuracy and completeness.
6. Review any supporting documents or attachments that need to be submitted with the form and ensure they are properly attached or included.
7. If any signatures are required, sign the form in the appropriate places.
8. Once you have filled out all the necessary information and completed any required attachments, review the entire form one last time to ensure everything is correct.
9. Finally, submit the completed form to the designated recipient or follow the instructions provided to send it through the appropriate channels.

Who needs 0938 1230:

Individuals who are required by a specific organization or institution to fill out form 0938 1230.

Note: Without specific information about the purpose or nature of form 0938 1230, it is not possible to provide more detailed or specific information regarding who exactly needs it.

• Who needs a CMS Form 40B?
• What is the Application for Enrollment in Medicare Part B Form for?
• Is Form CMS-40B accompanied by other forms?
• • When is Application for Enrollment in Medicare Part B Form due?
  • How do I fill out the Application for Enrollment in Medicare Part B Form?
  • Where do I send CMS-40B Form?

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.

Video instructions and help with filling out and completing 0938 1230

Instructions and Help about application enrollment medical form

Today we're going to discuss the most common situations when enrolling in Medicare Part A and Medicare Part B so don't touch that dial hi I'm Tim Danbury author of Medicare blueprint, so we're going to go over the most common situations that were asked about when enrolling in Medicare Part A and Medicare Part B be sure to stay to the end of the video to receive your free offer now let's get started the first scenario is I'm turning 65 and three months and I currently receive my Social Security income benefits what do I do if you're already receiving Social Security benefits before turning 65 you don't have to do anything the Social Security Administration will automatically enroll you in Medicare Part A and Medicare Part B you'll receive your red white and blue Medicare card in the mail usually about three months before you turn 65 however if you work for a company with more than 20 full-time employees and are staying on the group insurance plan at work you usually don't need Part B coverage if you want to decline Part B then you'll need to follow the instructions that come with your Medicare ID card and send the card back we do recommend that you compare your Medicare options with your current employers for coverage most times we found that Medicare with a supplement can provide better coverage at a lower cost if you do decide to keep the card you automatically keep Part B, and you'll need to pay the Part B premium if you decide to stay on your employer's plan then when you come off the employer's plan sometime down the road you'll need to sign up for Part B coverage at that time be aware that there are penalties for not signing up for Medicare Part B but for now know that you will not be penalized for delaying coverage under Part B if you already have credible insurance coverage from an employer your employers group coverage will normally be considered credible coverage ask your HR department if you have any questions on this they can tell you if your insurance is credible or not now we talked about Social Security benefits in the first example because it has an impact on how you enroll in Medicare however if you're going to take your Social Security income benefits at 65 or wait until you receive your full retirement benefits later that will not impact how you sign up on Medicare Part A or Medicare Part B we do feel it's important to let you know that when you decide to take your Social Security income benefits at very least call and make an appointment with the Social Security Administration and review all your options remember like Medicare you usually only have one chance to do this correctly make sure you're getting the benefits you deserved, and you've worked for all these years so now let's look at the next scenario I'm turning 65 and three months what do I need to do well you have some decisions to make in most situations you'll need to sign up for Medicare Part A and maybe Medicare Part B depending on how you're going to be covered at...

People Also Ask about 0938 1230

How do I know if my application for Medicare Part B is approved?

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.

Can I submit my Medicare Part B Application online?

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.

How long does it take for a Medicare Part B Application to be approved?

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.

How fast can you get Medicare B?

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.

What form do I use for Medicare Part B?

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.

How do I send Medicare forms?

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.

For pdfFiller’s FAQs

What is 0938 1230?

It is a time in military format. The time translates to 9:38 AM and 12:30 PM.

Who is required to file 0938 1230?

It is not possible to answer this question as provided. The information required to answer this question is incomplete.

What is the purpose of 0938 1230?

0938 1230 is a military time code that is used to indicate a specific time, in this case 9:38AM and 12:30PM.

What information must be reported on 0938 1230?

On a 0938 1230 report, the following information must be reported: Date, location, time of incident, type of incident, number of victims, any injuries sustained, any suspects involved, and any further details that may be relevant.

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