SIGN UP FOR MEDICARE PART B ONLINE

For many people, signing up for Medicare Part B doesn’t require you to leave the comfort of home.  Please visit our Medicare Part B webpage at secure.ssa.gov/acu/ophandler/loginSuccess  if:

• You’re enrolled in Medicare Part A.
• You would like to enroll in Part B during the Special Enrollment Period.
  

You can complete form CMS-40B (Application for Enrollment in Medicare – Part B [Medical Insurance]) at www.cms.gov/Medicare/CMS-Forms/CMS-Forms/CMS-Forms-Items/CMS017339 and CMS-L564 at www.cms.gov/Medicare/CMS-Forms/CMS-Forms/Downloads/CMS-L564E.pdf (Request for Employment Information) online.

You can also fax the CMS-40B and CMS-L564 to 1-833-914-2016; or return forms by mail to your local Social Security office.  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 GHP or LGHP.
• 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.