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- Sign up for Part B only | SSA
If you have a special situation, fill out the Application for Medicare Part A and B — Special Enrollment Period (Exceptional Conditions) (CMS-10797) (PDF) Find your Social Security office and fax or mail us the completed form
- Medicare Part A and Part B Special Enrollment Period Form
what is the purpose of this form? If, due to an exceptional condition, you didn’t sign up for Medicare Premium Part A or Part B during your Initial Enrollment Period (IEP), General Enrollment Period (GEP), or a Special Enrollment Period (SEP) you were previously
- Enrollment Forms - Medicare
To sign up for Part B in one of these situations, you’ll also need to fill out and submit an Application for Enrollment in Part B (CMS-40B) form at the same time Sign up for Part A Part B using a Special Enrollment Period
- Medicare Part B Special Enrollment Period - Medicare Rights Center
How can I obtain a Part B SEP? To obtain an SEP to enroll into Part B, contact the Social Security Administration (SSA) at 800-772-1213 and request the following two forms: CMS 40B (Application for Enrollment in Medicare) CMS L564 (Request for Employment Information)
- The Medicare Part B special enrollment period
What is the Medicare Part B special enrollment period (SEP)? The Medicare Part B SEP allows you to delay taking Part B if you have coverage through your own or a spouse’s current job, and then sign up for Part B — without a late enrollment penalty — as long as you do so within eight months of the active employment ending (or the employer
- EN-05-10012- How to Apply for Medicare Part B During Your Special . . .
How to Apply for Medicare Part B (Medical Insurance) During Your Special Enrollment Period At age 65, most people in the United States should enroll in Original Medicare (Part A and Part B) However, since Part B has a monthly premium that must be paid, some people sign up for Part A only They don’t enroll in Part B at age 65, because they:
- CMS40B - Application for Enrollment in Part B | CMS
You can use this form to sign up for Part B: During your Initial Enrollment Period (IEP) when you’re first eligible for Medicare; During the General Enrollment Period (GEP) from January 1 through March 31 of each year; If you’re eligible for a Special Enrollment Period (SEP), like if you’re covered under a group health plan (GHP) based on
- Sign up for Medicare Part B Online, by Fax, or by Mail
If you are age 65 or older and would like to enroll in Part B during a Special Enrollment Period (SEP) because your employer group health plan is ending or ended within the last 8 months, please visit our Sign up for Part B only webpage You can complete your Medicare Part B Enrollment online
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