This version of the form is not currently in use and is provided for reference only. Download this version of Form CMS-40B for the current year.
This is a legal form that was released by the U.S. Department of Health and Human Services - Centers for Medicare and Medicaid Services on May 1, 2021 and used country-wide. As of today, no separate filing guidelines for the form are provided by the issuing department.
Q: What is Form CMS-40B?
A: Form CMS-40B is the application form used to enroll in Medicare Part B (Medical Insurance).
Q: Who uses Form CMS-40B?
A: Anyone who is eligible for Medicare Part B can use Form CMS-40B to apply for enrollment.
Q: What is Medicare Part B?
A: Medicare Part B is the portion of Medicare that covers medically necessary services like doctor visits, outpatient care, and preventive services.
Q: How do I complete Form CMS-40B?
A: You will need to provide your personal information, Medicare number, and sign the form to complete it.
Q: Is there a deadline for submitting Form CMS-40B?
A: There is no specific deadline for submitting Form CMS-40B, but it is recommended to apply as soon as you are eligible for Medicare Part B.
Q: What happens after I submit Form CMS-40B?
A: Once your application is processed, you will receive a Medicare card with your Part B effective date.
Q: Can I make changes to my enrollment after submitting Form CMS-40B?
A: Yes, you can make changes to your enrollment during certain enrollment periods or if you qualify for a Special Enrollment Period.
Q: What if my Form CMS-40B is denied?
A: If your application is denied, you will receive a notice explaining the reason for denial and your appeal rights.
Form Details:
Download a fillable version of Form CMS-40B by clicking the link below or browse more documents and templates provided by the U.S. Department of Health and Human Services - Centers for Medicare and Medicaid Services.