Medicare Enrollment Application

What is Medicare Enrollment Application?

A Medicare Enrollment Application is a form that individuals need to complete in order to enroll in Medicare, the federal health insurance program for people who are 65 or older, certain younger individuals with disabilities, and people with end-stage renal disease.

What are the types of Medicare Enrollment Application?

There are different types of Medicare Enrollment Applications depending on the specific circumstances of the individual. These include:

Original Medicare (Parts A and B) Enrollment Application
Medicare Advantage (Part C) Enrollment Application
Medicare Prescription Drug Coverage (Part D) Enrollment Application
Medicare Savings Program Application
Extra Help with Medicare Prescription Drug Plan Costs Application

How to complete Medicare Enrollment Application

Completing a Medicare Enrollment Application is a straightforward process. Here are the steps involved:

01
Gather all the necessary personal and medical information
02
Review the different types of Medicare Enrollment Applications to determine which one you need
03
Carefully read the instructions provided on the application form
04
Fill out the application form completely and accurately
05
Submit the completed application by mail or online
06
Keep a copy of the application for your records

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Questions & answers

Centers for Medicare & Medicaid Services (CMS). The link on the CMS website will help you search for the forms you need. Just print the forms, fill them out, and send them to the address listed on the forms. Official U.S. Government Site for Medicare.
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.
❖ 855I. • CMS form which enrolls physicians and non-physician practitioners who. render Medicare Part B services to beneficiaries. • Enrolls practitioners who are the sole owner of a professional corporation. and bill Medicare through this business entity.
Visit Medicare's website, Medicare.gov, to get more information about Original Medicare, Medicare Advantage, or Part D coverage. or to download a copy of the publication Medicare & You (Publication No. CMS-10050). You can also call the Medicare toll-free number at 1-800-633-4227. TTY users can call 1-877-486-2048.
Contact Social Security to sign up for Part B: Fill out Form CMS-40B (Application for Enrollment in Medicare Part B). Call 1-800-772-1213. Contact your local Social Security office. If you or your spouse worked for a railroad, call the Railroad Retirement Board at 1-877-772-5772.
Medicare Enrollment Form On the Social Security website. By visiting a local Social Security office. By calling Social Security at 1-800-772-1213. TTY users can call 1-800-0778.