medicare part b form
You use the Medicare Part B form (CMS-40B) when you already have Part A and want to sign up for Part B medical insurance, and you can download and submit it through Social Security or Medicare channels.
What is the Medicare Part B form?
- The main Medicare Part B form is called “Request for Enrollment in Medicare Part B (Medical Insurance)” – CMS-40B.
- It is used when you already have Medicare Part A but need to enroll in Part B for doctor visits, outpatient services, and other medical coverage.
When do you use this form?
- During your Initial Enrollment Period (around when you turn 65 or first become eligible for Medicare).
- During the General Enrollment Period (January 1–March 31 each year) or in certain Special Enrollment Period situations tied to employer coverage.
Where to get the Medicare Part B form
- You can download the current CMS-40B directly from official Medicare/CMS pages in PDF format.
- Medicare’s “Forms” or “Enrollment forms” pages list Part B enrollment forms and related documents like CMS-L564 (Request for Employment Information) if you are enrolling using employer coverage.
Key sections of the form
- Basic information: Medicare number, name, and mailing address.
- Questions on current work/coverage: Including international volunteer or employer coverage details when applicable.
- Signature and date: You must sign and date; a witness section is included if you sign with a mark instead of a signature.
How to submit the Medicare Part B form
- You typically mail or fax the completed CMS-40B to your local Social Security office , whose contact information can be found via the Social Security “office locator.”
- In many cases, you may also handle Part B enrollment or upload supporting forms through online Social Security/Medicare portals , especially for Special Enrollment Periods.
| Form | What it’s called | What it’s used for |
|---|---|---|
| CMS-40B | Request for Enrollment in Medicare Part B | Sign up for Part B when you already have Part A. | [9][5]
| CMS-L564 | Request for Employment Information | Provide proof of employer coverage to qualify for a Part B Special Enrollment Period. | [1][9]
Information gathered from public forums or data available on the internet and portrayed here.