Big Idea

• No need to leave the comfort of home
• Enrolled in Medicare Part A? Now enroll in Part B during the special enrollment period.
• See the forms below
• Read more…

Stay home. Enroll in Medicare Part B.

For many people, signing up for Medicare Part B doesn’t require you to leave the comfort of home.  Please visit our Medicare Part B webpage at secure.ssa.gov/acu/ophandler/loginSuccess  if:

•  You’re enrolled in Medicare Part A.
•  You would like to enroll in Part B during the Special Enrollment Period.

You can complete form CMS-40B (Application for Enrollment in Medicare – Part B [Medical Insurance]) at www.cms.gov/Medicare/CMS-Forms/CMS-Forms/CMS-Forms-Items/CMS017339 and CMS-L564 at www.cms.gov/Medicare/CMS-Forms/CMS-Forms/Downloads/CMS-L564E.pdf (Request for Employment Information) online.

You can also fax the CMS-40B and CMS-L564 to 1-833-914-2016; or return forms by mail to your local Social Security office.  Please contact Social Security at 1-800-772-1213 (TTY 1-800-325-0778) if you have any questions.  

Note: When completing the forms:

•  State, “I want Part B coverage to begin (MM/YY)” in the remarks section of the CMS-40B form or online application.
•  If your employer is unable to complete Section B, please complete that portion as best you can on behalf of your employer without your employer’s signature.
•  Submit one of the following types of secondary evidence by uploading it from a saved document on your computer: 
•  Income tax returns that show health insurance premiums paid.
•  W-2s reflecting pre-tax medical contributions.
•  Pay stubs that reflect health insurance premium deductions.
•  Health insurance cards with a policy effective date.
•  Explanations of benefits paid by the GHP or LGHP.
•  Statements or receipts that reflect payment of health insurance premiums.

Please let your friends and loved ones know about this online, mail, or fax option.