Medicare Part B Open Enrollment Form

If you don t have medicare or you want to sign up for part a some people have to pay a premium for part a contact social security. 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. Most people get medicare part b medical insurance when they turn 65.

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Deciding to enroll in part b is an important decision.

Medicare part b open enrollment form.

Social security and the centers for medicare medicaid services cms need your information to determine if you. The social security act as amended 42 u s c. Social security and the centers for medicare medicaid services cms need your information to determine if you re entitled to part b. 1395o 1395s and 1395ii for your enrollment in medicare part b.

If you are already enrolled in medicare part a and you want to enroll in part b please complete form cms 40b application for enrollment in medicare part b medical insurance. Part b also covers many preventive services. You waited to sign up for part b until march 2019 during the general enrollment period. This form is available both in english and spanish.

Complete an application for enrollment in part b cms 40b to sign up for part b. However you need to have part b if you want to buy part a. Get this form and instructions in spanish. If you didn t sign up for part b then now s the time to decide if you want to enroll.

Most people should enroll in part a when they turn 65 but certain people may choose to delay part b. Part b coverage is your choice. To sign up for part b complete an application for enrollment in part b cms 40b. Get this form and instructions in spanish.

1395o 1395s and 1395ii for your enrollment in medicare part b. Fill out the application for enrollment in part b cms 40b. Your coverage starts july 1 2019. Should i get part b.

Find out more about whether you should take part b. During medicare s general enrollment period january 1 march 31 you can enroll in part b and your coverage will start july 1. Medicare part b medical insurance part b helps cover medically necessary services like doctors services outpatient care and other medical services that part a doesn t cover. Your part b premium penalty is 20 of the standard premium and you ll have to pay this penalty for as long as you have part b.

If you are applying for medicare part b due to a loss of employment or group health coverage you will also need to complete form cms l564 request for employment. I have part a and want to apply for part b application for enrollment in part b cms 40b.

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