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 at secure.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.
Forms CMS-40B (Application for Enrollment in Medicare Part B Medical Insurance) and CMS-L564 (Request for Employment Information) may be found at tinyurl.com/CMS-40B-Form and tinyurl.com/CMS-L564, respectively.
You may complete them online, fax them to 1-833-914-2016 or return by mail to your local Social Security office. Please contact Social Security at 1-800-772-1213 (TTY 1-800-325-0778) 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.
MEDICARE PART B FORMS
• CMS-40B (Application for Enrollment in Medicare Part B): tinyurl.com/CMS-40B-Form.
• CMS-L564 (Request for Employment Information): tinyurl.com/CMS-L564.
SOCIAL SECURITY OFFICES
• Mecosta, Osceola counties: 502 N State St. Ste. A, Big Rapids, MI 49307
• Lake County: 150 N. Jebavy Drive, Ludington, MI 49431