You can sign up for Medicare Part B online! If you’re enrolled in Medicare Part A and want to enroll in Part B during the Special Enrollment Period, please visit our Medicare web page at www.ssa.gov/benefits/medicare/.
From there, you can enroll in Part B by completing these forms: CMS-40B (Application for Enrollment in Medicare – Part B [Medical Insurance]) and CMS-L564 (Request for Employment Information).
You can also fax or mail the CMS-40B and CMS-L564 to your local Social Security office to enroll. You can find the fax number and address for your local office at www.ssa.gov/locator. 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 Group Health Plan or Large Group Health Plan.
- 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.
