Social Security Medicare Part A Application Form

If you are already enrolled in medicare part a and you want to enroll in part b please complete form cms 40b application for enrollment in medicare part b medical insurance.

Social security medicare part a application form.

Many forms must be completed only by a social security representative. Visit your local social security office. Social security office u s. Or return the forms by mail to your local social security office.

Social security enrolls you in original medicare part a and part b. You can complete an application for retirement spouse s medicare or disability benefits online. You can also fax your enrollment forms and evidence of employment to 1 833 914 2016. Get this form and instructions in spanish.

An appointment is not. If you worked for a railroad call the rrb at 1 877 772 5772. You can help by being ready to provide the information and. Medicare part a hospital insurance helps pay for inpatient care in a hospital or limited time at a skilled nursing facility following a hospital stay.

It begins 3 months before your 65th birthday or 25th month of disability and ends 3 months after you reach 65 or 3 months. The form you are looking for is not available online. Fax them to 1 833 914 2016. You may complete the forms online by visiting the apply for medicare part b online during a special enrollment period webpage.

Or contact your local social security office. If you do not wish to use the online application or the application for the benefit you want is not available online you can. Visit faq ssa gov or call social security toll free at 1 800 772 1213 for more information. If you do not live in the u s.

Part a also pays for some home health care and hospice care. 1395o 1395s and 1395ii for your enrollment in medicare part b. If you have questions please contact social security at 1 800 772 1213 tty 1 800 325 0778. If you are applying for medicare part b due to a loss of employment or group health coverage you will also need to complete form cms l564 request for employment.

Or by calling our national toll free service at 1 800 772 1213 tty 1 800 325 0778 or visiting your local social security office. Medicare at any age. If you already have part a and want to sign up for part b complete an application for enrollment in part b cms 40b. Call social security at 1 800 772 1213 tty.

Please call us at 1 800 772 1213 tty 1 800 325 0778 monday through friday between 8 a m. Or one of its territories you can also contact your nearest u s. Call us at 1 800 772 1213 tty 1 800 325 0778. Contact social security if you want to apply for medicare for the first time.

If you do not have part a do not complete this form. Call ahead to make an appointment. Social security is authorized to collect your information under sections 1836 1840 and 1872 of the social security act as amended 42 u s c.