| If you missed your initial enrollment period when you first became eligible for Medicare, you can only sign up for Part A and/or Part B during the General Enrollment Period, which runs from January 1 to March 31 each year. Your coverage will begin the first of the month following the month you enrolled during the General Enrollment Period. You cannot use the annual open enrollment period that runs from October 15 to December 7 to enroll in Medicare Part A or Part B. That enrollment period can only be used by people with Medicare to sign up for drug coverage or Medicare Advantage coverage, or switch coverage that you already have. Show
Administration at 1-800-772-1213 to enroll in Medicare or to ask questions about whether you are eligible. You can also visit their web site at www.socialsecurity.gov. The Medicare.gov Web site also has a tool to help you determine if you are eligibile for Medicare and when you can enroll. It is called the Medicare Eligibility Tool. If you already receive benefits from Social Security:If you already get benefits from Social Security or the Railroad Retirement Board, you are automatically entitled to Medicare Part A (Hospital Insurance) and Part B (Medical Insurance) starting the first day of the month you turn age 65. You will not need to do anything to enroll. Your Medicare card will be mailed to you about 3 months before your 65th birthday. If your 65th birthday is February 20, 2010, your Medicare effective date would be February 1, 2010. (Note: if your birthday is on the 1st day of any month, Medicare Part A and Part B will be effective the 1st day of the prior month. For example, if your 65th birthday is February 1, 2010, your Medicare effective date would be January 1, 2010.) If you are not getting Social Security benefits:If you are not getting Social Security benefits, you can apply for retirement benefits online. If you would like to file for Medicare only, you can apply by calling 1-800-772-1213. If you are under age 65 and disabled, and have been entitled to disability benefits under Social Security or the Railroad Retirement Board for 24 months, you will be automatically entitled to Medicare Part A and Part B beginning the 25th month of disability benefit entitlement. You will not need to do anything to enroll in Medicare. Your Medicare card will be mailed to you about 3 months before your Medicare entitlement date. (Note: If you are under age 65 and have Lou Gehrig's disease (ALS), you get your Medicare benefits the first month you get disability benefits from Social Security or the Railroad Retirement Board.) For more information about enrollment, call the Social Security Administration at 1-800-772-1213 or visit the Social Security web site. See also Social Security's Medicare FAQs. NOTE: Your IEP lasts for 7 months. It begins 3 months before your 65th birthday (or 25th month of disability) and ends 3 months after you reach 65 (or 3 months after the 25th month of disability).WHAT INFORMATION DO YOU NEED TO COMPLETE THIS APPLICATION?You will need:
WHAT HAPPENS NEXT?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. HOW DO YOU GET HELP WITH THIS APPLICATION?
REMINDERS
You have the right to get Medicare information in an accessible format, like large print, Braille, or audio. You also have the right to file a complaint if you feel you’ve been discriminated against. Visit https://www.medicare.gov/about-us/accessibilitynondiscrimination-notice, or call 1-800-MEDICARE (1-800-633-4227) for more information. TTY users can call 1-877-486-2048. CMS-40B (04/19)
DEPARTMENT OF HEALTH AND HUMAN SERVICES Form Approved APPLICATION FOR ENROLLMENT IN MEDICARE PART B (MEDICAL INSURANCE)1. Your Medicare Number 2. Do you wish to sign up for Medicare Part B (Medical Insurance)? YES 3. Your Name (Last Name, First Name, Middle Name) 4. Mailing Address (Number and Street, P.O. Box, or Route) 5. City State Zip code 6. Phone Number (including area code) () -
7. Written Signature (DO NOT PRINT) 8. Date Signed / /
IF THIS APPLICATION HAS BEEN SIGNED BY MARK (X), A WITNESS WHO KNOWS THE APPLICANT 9. Signature of Witness 10. Date Signed / /
11. Address of Witness 12. Remarks According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unless it displays a valid OMB control number. The valid OMB control number for this information collection is 0938-1230. The time required to complete this information is estimated to average 15 minutes per response, including the time to review instructions, search existing data resources, gather the data needed, and complete and review the information collection. If you have any comments concerning the accuracy of the time estimate(s) or suggestions for improving this form, please write to: CMS, Attn: PRA Reports Clearance Officer, 7500 Security Boulevard, Baltimore, Maryland 21244-1850. Do you automatically get Part A and B Medicare?You'll automatically get Part A but not Part B. You must call Social Security at (1-800-772-1213) to sign up for Part B. TTY users can call 1-800-325-0778. If you don't enroll in Part B when you're first eligible, you may have to pay a late enrollment penalty for as long as you have Part B.
Can I submit my Medicare Part B application online?Apply online (at Social Security) – This is the easiest and fastest way to sign up and get any financial help you may need. You'll need to create your secure my Social Security account to sign up for Medicare or apply for Social Security benefits online. Call 1-800-772-1213. TTY users can call 1-800-325-0778.
How long does it take to get Medicare Part B after applying?Your coverage starts the first day of the month after you sign up. You may not have signed up for Medicare at age 65, perhaps because you have health coverage through an employer or a Health Savings Account. If so, you can apply on our website using our online Medicare application at www.ssa.gov/benefits/medicare/.
Can you add Medicare Part B at any time?If you did not enroll for Part B during your initial enrollment period, you may qualify for a Special Enrollment Period (SEP) to sign up for Part B (and/or Part A) anytime as long as you or a spouse is working and you're covered by a group health plan through that employment.
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Apply for medicare part a and b online
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