Enrollment Forms
- 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.
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.