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  • Sign up for Part B only | SSA
    Fill out the Application for Enrollment in Medicare Part B (CMS-40B) (PDF) If you are applying during the Special Enrollment Period, also fill out the Request for Employment Information (CMS-L564) (PDF)
  • Sign up for Medicare Part B Online, by Fax, or by Mail
    If you are age 65 or older and would like to enroll in Part B during a Special Enrollment Period (SEP) because your employer group health plan is ending or ended within the last 8 months, please visit our Sign up for Part B only webpage You can complete your Medicare Part B Enrollment online
  • CMS40B - Application for Enrollment in Part B | CMS
    This form is your application for Medicare Part B (Medical Insurance) You can use this form to sign up for Part B: During your Initial Enrollment Period (IEP) when you’re first eligible for Medicare; During the General Enrollment Period (GEP) from January 1 through March 31 of each year
  • The Part B Special Enrollment Period - Medicare Rights Center
    • When you enroll during the GEP, coverage begins the first of the month after you enroll For example, if you enroll in January, your coverage begins February 1 Medicare Part B Special Enrollment Period Beneficiary: [Name] SSN: [Social Security Number] To whom it may concern, I am submitting my application for enrollment into Medicare
  • Sign up for Medicare Part B now through March 31
    You have until March 31, 2025 to sign up for Part B Your Part B coverage will start the first day of the month after you sign up You can sign up by: • Downloading Form CMS-40B (Application for Enrollment in Medicare Part B) at Medicare gov basics forms-publications-mailings forms enrollment Complete the application and sign it
  • The Medicare Part B special enrollment period
    How do I use the Part B SEP? To use this SEP you should call the Social Security Administration at 1-800-772-1213 and request two forms: the Part B enrollment request form (CMS 40B) and the request for employment information form (CMS L564)
  • Applying for Medicare Part B Online: A Step-by-Step Guide for Special . . .
    Applying for Medicare Part B using the SEP is a great option for those who missed their initial enrollment period Follow the steps outlined above and use the link provided to access the online application
  • How do I sign up for Medicare Part B if I already have Part A?
    If you qualify for an SEP, you can apply online at Apply for Medicare Part B Online during a Special Enrollment Period You can also fax or mail your completed Application for Enrollment in Medicare - Part B (CMS-40B) and the Request for Employment Information (CMS-L564) enrollment forms and evidence of employment to your local Social Security
  • Delayed Medicare Part B?: You Can Apply Online - Senior65
    To enroll online for Medicare Part B during a SEP, you will need to complete and submit the “Request for Employment Information” form L564 and The “Application for Enrollment in Medicare Part B” Follow these steps to apply for Medicare Part B online
  • Application for Enrollment in Medicare Part B (Medical Insurance)
    • If you want to sign up for Part B during the General Enrollment Period (GEP) from January 1 – March 31 each year • If you’re eligible for a Special Enrollment Period (SEP) • If you’re in your Initial Enrollment Period (IEP) and live in Puerto Rico You must sign up for Part B using this form NOTE: Your IEP lasts for 7 months





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