Medicare

Sign up for Medicare Part B Online, by Fax or Mail

August 6, 2020 • By

Last Updated: August 6, 2020

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 if:

  1. You are already enrolled in Medicare Part A.
  2. 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]) and CMS-L564 (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.

 


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Darlynda Bogle, Assistant Deputy Commissioner

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