CMS Form CMS 40B

2025 Printable Template

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Form last updated: 03/2024. Please verify this is the current version before use.

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01

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How to fill out a CMS 40B online?

Follow these steps to complete your CMS 40B form online.

Step 01

Obtain Form CMS-40B from the official CMS or SSA website.

Step 02

Fill out all required personal information fields accurately.

Step 03

Indicate the reason for your Part B application.

Step 04

Review all entries for accuracy.

Step 05

Sign the form.

Step 06

Submit the completed form to your local Social Security office or follow instructions for submission during a Special Enrollment Period.

Centers for Medicare & Medicaid Services (CMS)

What is a CMS 40B used for?

Form CMS-40B is used by individuals who are eligible for Medicare and wish to enroll in Medicare Part B, which provides medical insurance coverage. This form is important for those who did not sign up for Part B when they were first eligible and are now seeking to enroll during a Special Enrollment Period or General Enrollment Period.

Who needs to fill out a CMS 40B form

Individuals eligible for Medicare who are applying for Medicare Part B coverage.

What is Form CMS-40B?

Form CMS-40B is the application used to enroll in Medicare Part B, which covers medical services.

When can I submit Form CMS-40B?

You can submit the form during your Initial Enrollment Period, Special Enrollment Period, or General Enrollment Period.

How can I obtain a blank Form CMS-40B?

You can access a blank version of Form CMS-40B from the Centers for Medicare & Medicaid Services or the Social Security Administration.

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