Form CMS-40B Application for Enrollment in Medicare Part B (Medical Insurance)

Form CMS-40B Application for Enrollment in Medicare Part B (Medical Insurance)

What Is a Medicare Part B Application?

Form CMS-40B, Application for Enrollment in Medicare Part B, is a document developed by the Centers for Medicare & Medicaid Services (CMS). The application is supposed to be used by individuals when they want to apply for enrollment in Medicare Part B, insurance which provides outpatient medical coverage. The purpose of the document is to provide the Social Security Administration with the information they need to process a request for enrollment.

The CMS has also issued a Spanish version of the document - Formulario CMS-40B, Solicitud De Inscripcion Para Medicare Parte B (Seguro Medico), which can be used by those applicants who speak Spanish.

The application was last revised on May 1, 2021. A CMS-40B fillable form is available for download below.

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Medicare Form CMS-40B Instructions

The CMS-40B Application is easy to fill out, however before that, an applicant must check if they are eligible for Medicare Plan B. The first and the most important requirement - a filer must have Medicare Part A, insurance which provides inpatient hospital coverage. If they don't have it yet and they want to apply for Medicare they should contact their Social Security Administration services. Other conditions when a filer can apply for Medicare Plan B are:

  • If an applicant is in their Initial Enrollment Period (IEP) and lives in Puerto Rico. The IEP is the first time an applicant can sign up for Medicare and it lasts for seven months: three months before an applicant's 65th birthday, the month of the birthday, and three months after an applicant's 65th birthday;
  • If an applicant is in their IEP and refused Part B or did not sign up when they applied for Medicare;
  • If you want to sign up for Part B during the General Enrollment Period (GEP) each year. GEP is the time period between January 1 and March 31 of every year;
  • If an applicant refused Part B during their IEP because they had group health plan coverage through their or their spouse's current employment. They may sign up during their eight-month Special Enrollment Period (SEP). The SEP is the time outside the annual open enrollment period. A filer can qualify for the SEP if they have had certain life events, like moving, marriage, or having a baby;
  • If an applicant has Medicare due to a disability and refused Part B during their IEP because they had group health plan coverage through their, their spouse's, or their family member's current employment;
  • An applicant may sign up during their eight-month SEP.

If an applicant is eligible and still wants to sign up for medical insurance under Medicare, then they should go on with the application. The document consists of four pages, but the application itself takes only one page - the other three are instructions. They provide information on who can use this document, what information a filer needs to complete this document, how to submit the application, and where to find help if needed. The application requires the following information:

  1. Applicant's Medical Number. The unique number that a filer can find on their medicare card.
  2. Name. Full name must be provided.
  3. Mailing Address. Individuals must write their full mailing address including street name, number, PO box, etc.
  4. City. A filer should state the name of the city, state, and zip code for the mailing address.
  5. Phone Number. Applicants should enter the phone number with area code.
  6. Signature and date. The signature must be written, not printed.

The document has an additional part that is supposed to be filled in only if the information in the application was supplied by a witness who knows the applicant, as well as an area for remarks - in case an applicant would like to provide any additional information they consider important.

Where to Mail Medicare Part B Application?

After completing the CMS-40B Form, a filer should submit it to their local Social Security office. To find the closest one an applicant should visit the official website of the U.S. Social Security Administration.

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