Form CMS-40B: Application for Enrollment in Medicare – Part B (Medical Insurance)

About this Form:

Form CMS-40B is used to apply for Medicare Part B medical insurance.

How do I fill out Form CMS-40B?

The purpose of Form CMS-40B is to file for Medicare Part B when you have already enrolled in Part A. Starting at the top on line1, enter your Medicare number. Moving to line 2, check the box if you want to sign up for Medicare Part B. Down to line 3, enter your last name, followed by your first name, and then your middle name. Line 4 asks for your mailing address street number and name. If you use a PO Box or live on a rural route, enter that information in the space provided. For line 5, enter your city’s mailing address, state abbreviations, and your zip code. On line 6, enter your best contact number, including area code. For line 7, you must sign your name. Make sure you do not print and only write your signature. Then, for line 8 enter todays’ date in mm/dd/yyyy format. For example, if today’s date is June 1, 2020, then you would write 06/01/2020. If you signed your name with an X, continue to fill out lines 9-12, otherwise move to line 12. Line 9 needs the signature of the witness who was with the applicant when they filled out this form. For line 10, enter today’s date in mm/dd/yyyy format. On line 11, enter the address of the witness. For line 12 enter any remarks that will help clarify information about this application. You have now completed Form CMS-40B.  

Form CMS-40B: Application for Enrollment in Medicare – Part B (Medical Insurance): FAQs

  • Form CMS-40B is used to apply for Medicare Part B medical insurance.

  • Yes, the purpose of Form CMS-40B is to file for Medicare Part B when you have already enrolled in Part A.

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