CMS-40B S 2018 free printable template
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Formulation Abroad
OMB No. 09381230
Caducei: 02/2020DEPARTAMENTO DE SALAD Y SERVICES HUMANS
CENT ROS DE SERVICES DE MEDICARE Y MEDICAIDSOLICITUD DE INSCRIPTION PARA MEDICARE PART B (SEGURA MEDICO)
QUIN
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How to fill out CMS-40B S
01
Obtain the CMS-40B S form from the official CMS website or through your healthcare provider.
02
Fill in your personal information at the top of the form, including your name, date of birth, and Medicare number.
03
Indicate the reason for your request on the form, specifying whether it’s for initial enrollment or changes in coverage.
04
Provide details about your current health coverage, including policy numbers and effective dates.
05
Review the eligibility requirements and ensure you meet the criteria for the program.
06
Sign and date the form to certify that all information provided is accurate.
07
Submit the completed form to your local Social Security Administration office or the designated Medicare processing center.
Who needs CMS-40B S?
01
Individuals who are eligible for Medicare and want to enroll, make changes to their coverage, or switch plans.
02
Those who are transitioning to Medicare due to age (turning 65) or disability.
03
Individuals seeking to apply for additional Medicare benefits.
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What is CMS-40B S?
CMS-40B S is a form used by the Centers for Medicare & Medicaid Services (CMS) to enroll eligible individuals in Medicare Part B, specifically for those who are not already enrolled in the program.
Who is required to file CMS-40B S?
Individuals who are eligible for Medicare and wish to enroll in or re-enroll in Medicare Part B after their initial enrollment period must file CMS-40B S.
How to fill out CMS-40B S?
To fill out CMS-40B S, individuals need to provide personal information including their name, address, Medicare number, and any other required details. It's important to follow the instructions provided in the form carefully.
What is the purpose of CMS-40B S?
The purpose of CMS-40B S is to facilitate the enrollment of eligible individuals into Medicare Part B, allowing them to access health care services under the program.
What information must be reported on CMS-40B S?
The information that must be reported on CMS-40B S includes the individual's personal details such as full name, date of birth, address, and Social Security number, as well as information regarding the current or previous Medicare coverage.
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