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.
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 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:
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.
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.