Medicare.gov

Enrollment Forms

Sign up for Part B

  • What’s the form called?
    Application for Enrollment in Part B (CMS-40B)
  • What’s it used for?
    Signing up for Part B when you already have Part A.


Give proof of employment when you sign up for Part B

  • What’s the form called?
    Request for Employment Information (CMS-L564)
  • What’s it used for?
    Giving the Social Security Administration proof you’re eligible to sign up for Part B if:
    • You’re still working.
    • You retired within the last 8 months.
    • You lost job-based health coverage within the last 8 months.
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 

  • What situations qualify for an exceptional conditions Special Enrollment Period?
  • What’s the form called?
    Application for Medicare Part A & Part B – Special Enrollment Period (Exceptional conditions) (CMS-10797)
  • What’s it used for?
    Signing up for Part A & Part B if you meet the criteria for a Special Enrollment Period.

 

Sign up for the Part B Immunosuppressive Drug benefit

  • What’s the form called?
    Application for Enrollment in Part B Immunosuppressive Drug Coverage (CMS-10798)
  • What’s it used for?
    Signing up for the Part B Immunosuppressive Drug benefit.