Fill out Section A and take the form to your employer. Ask your employer to fill out Section B. You need to get the completed form from your employer and include it with your Application for Enrollment in Medicare (CMS-40B). Then you send both together to your local Social Security office. Find your local office here: www.ssa.gov .
Full Answer
How can I apply for Medicare Part B?
REQUEST FOR EMPLOYMENT INFORMATION SECTION A: To be completed by individual signing up for Medicare Part B (Medical Insurance) 1. Employer's name 2. Date / / 3. Employer’s Address City State Zip code 4. Applicant’s Name 5. Applicant’s Social Security Number - - 6. Employee’s Name 7. Employee’s Social Security Number - -
What information is required to apply for Medicare Part?
Fill out an Application for Enrollment in Part B (CMS-40B) and a Request for Employment Information (CMS-L564). These forms are available both in English and Spanish. Appeals forms I want to appoint a representative to help me file an appeal (Appointment of Representative form/CMS-1696). Fill out the Appointment of Representative form (CMS-1696). This form is …
How to terminate Medicare Part B?
CENTERS FOR MEDICARE & MEDICAID SERVICES Form Approved OMB No. 0938-0787 REQUEST FOR EMPLOYMENT INFORMATION SECTION A: To be completed by individual signing up for Medicare Part B (Medical Insurance) 1. Employer’s Name 2. Date / / 3. Employer’s Address City State Zip Code 4. Applicant’s Name 5. Applicant’s Social Security Number – – 6.
How to enroll in Medicare Part B?
Jan 25, 2021 · After you and the employer both complete part A and part B of Form CMS-L564, you can submit the form along with your Application for Enrollment in Medicare (Form CMS-40B). Form CMS-40B is your actual Medicare Part B application and requires the following information: Your Medicare number Name, address and phone number
Why do people decline Medicare Part B?
Some people decline Medicare Part B when they first become eligible for it because they are still enrolled in the health insurance plan provided by their employer or that of a spouse. Before you are no longer enrolled in that employer group health plan, you may want to enroll in Medicare Part B.
What is CMS 40B?
After you and the employer both complete part A and part B of Form CMS-L564, you can submit the form along with your Application for Enrollment in Medicare (Form CMS-40B). Form CMS-40B is your actual Medicare Part B application ...
How long do you have to be in a special enrollment period to get Medicare?
In order to apply for Medicare in a Special Enrollment Period, you must have or had group health plan coverage within the last 8 months through your or your spouse’s current employment. People with disabilities must have large group health plan coverage based on your, your spouse’s or a family member’s current employment.
What is a group health plan?
A group health plan is any plan of one or more employers to provide health benefits or medical care (directly or otherwise) to current or former employees, the employer, or their families. 2. If yes, give the date the coverage began.
How to report Medicare fraud?
If you suspect Medicare fraud, waste, or abuse, you should immediately report fraud online. Alternatively, you can call the HHS Office of Inspector General at 1-800-447-8477 (TTY users 1-800-377-4950) or CMS at 1-800-633-4227 (TTY users 1-877-486-2048).
How old do you have to be to get Medicare?
How to Complete Medicare Enrollment Forms. As you approach the age of 65, you’ll want to make sure you enroll in the Medicare insurance plan that may suit your needs. To do so, you need to know how to sign up for Medicare and which Medicare application forms to complete.
What is Medicare prescription drug plan?
Medicare Prescription Drug Plans are available from private, Medicare-approved insurance companies. To qualify, you need to be enrolled in Medicare Part A and/or Part B and live in the plan’s service area. Plan availability, costs, and benefit details may vary. Read about enrollment periods for Medicare Prescription Drug Plans.
Is hospice covered by Medicare Advantage?
Medicare Advantage plans are offered by private health insurance companies that contract with Medicare to deliver your Medicare Part A and Part B benefits – with the exception of ho spice care, which is still covered under Part A.
