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 atsecure.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 (TTY1-800-325-0778) 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.