Social Security Medicare Part B Application Form

If you do not wish to use the online application or the application for the benefit you want is not available online you can. Call social security at 1 800 772 1213 tty. If you worked for a railroad call the rrb at 1 877 772 5772.

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You can complete an application for retirement spouse s medicare or disability benefits online.

Social security medicare part b application form.

You may complete the forms online by visiting the apply for medicare part b online during a special enrollment period webpage. Many forms must be completed only by a social security representative. Social security is authorized to collect your information under sections 1836 1840 and 1872 of the social security act as amended 42 u s c. Visit your local social security office.

State i want part b coverage to begin mm yy in the remarks section of the cms 40b form or the online application. Visit faq ssa gov or call social security to free at 1 800 772 1213 tty 1 800 325 0778 for more information. 1395o 1395s and 1395ii for your enrollment in medicare part b. This information is needed for ssa and the centers for medicare medicaid services cms to determine if you are entitled to supplementary medical insurance part b.

Social security is authorized to collect your information under sections 1836 1840 and 1872 of the social security act as amended 42 u s c. Or return the forms by mail to your local social security office. Fax them to 1 833 914 2016. 1395o 1395s and 1395ii.

If you don t already have part a you can apply online at ssa gov benefits medicare. You can also fax your enrollment forms and evidence of employment to 1 833 914 2016. If you have questions please contact social security at 1 800 772 1213 tty 1 800 325 0778. If you already have part a and want to sign up for part b complete an application for enrollment in part b cms 40b.

Call us at 1 800 772 1213 tty 1 800 325 0778. Visit faq ssa gov or call social security toll free at 1 800 772 1213 for more information. If you live in puerto rico you will not receive medicare part b medical insurance automatically. The form you are looking for is not available online.

Social security and the centers for medicare medicaid services cms need your information to determine if you. You will need to sign up for it during your initial enrollment period or you will pay a penalty. To sign up please call our toll free number at 1 800 772 1213 tty 1 800 325 0778 you also may contact your local social security office. When do i sign up.

The social security act as amended 42 u s c. An appointment is not. Get this form and instructions in spanish. 1395o 1395s and 1395ii for your enrollment in medicare part b.

Please call us at 1 800 772 1213 tty 1 800 325 0778 monday through friday between 8 a m. If you don t already have part a you can apply online at ssa gov benefits medicare. Or contact your local social security office.

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