Application For Enrollment In Medicare-Part B (Medical Insurance) {CMS-40B}

CMS-40B - APPLICATION FOR ENROLLMENT IN MEDICARE PART B (MEDICAL INSURANCE). Use this form if you already have Medicare Part A and want to sign up for Part B (Medical Insurance). You can use this form to sign up for Part B during these times: • During your Initial Enrollment Period • During the General Enrollment Period from January 1–March 31 each year • If you’re eligible for a Special Enrollment Period If you don’t have Part A, don’t complete this application. Contact Social Security to apply for Medicare for the first time. Visit Medicare.gov/basics/get-started-with-medicare to learn more about when you can sign up for Medicare, when your coverage can start, and special situations for people under 65 with a disability. www.FormsWorkflow.com