Late enrollment penalty: 10% higher premiums for each 12-month period you could have had Part B but didn't

If you have employer coverage, you may not need Part B yet — check with your employer

Medicaremoderate

Medicare Part B Enrollment

CMS-40B · CMS

Application for enrollment in Medicare Part B (medical insurance). Used during Initial Enrollment, General Enrollment, or Special Enrollment Periods.

Form Details

Total fields: 35
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Time without BeneFill: 30 minutes
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Filled by: patient
Frequency: one time

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Where to Submit This Form

📬

Mail to your local SSA office

https://secure.ssa.gov/ICON/main.jsp

Medicare enrollment is handled by Social Security.

🏢

In person at local SSA office

Filing Deadline

General Enrollment: Jan 1 – Mar 31 each year (coverage starts July 1). Special Enrollment: within 8 months of losing employer coverage.

Required Attachments

📎 CMS-L564 (proof of employer coverage) if applying during Special Enrollment Period

Processing Time

2-4 weeks. Your Medicare card will be mailed to you.

Tips for This Form

✓ Late enrollment penalty: 10% higher premiums for each 12-month period you could have had Part B but didn't
✓ If you have employer coverage, you may not need Part B yet — check with your employer

You Might Also Need

Request for Employment Information

CMS-L564 · CMS

Employer verification of group health plan coverage dates. Required alongside CMS-40B when using a Special Enrollment Period after employer coverage ends.

Extra Help / Low-Income Subsidy Application

SSA-1020 · SSA

Application for Extra Help with Medicare prescription drug plan costs. Can save up to $5,000/year on Part D premiums, deductibles, and copays.

Medicare Savings Program Application

State-specific MSP form · State Medicaid Agencies

Application for QMB, SLMB, or QI programs that help pay Medicare premiums, deductibles, and copays. Over 6 million eligible but unenrolled.

Part A/B Special Enrollment (Exceptional Conditions)

CMS-10797 · CMS

Application for Medicare Part A and Part B during a Special Enrollment Period for exceptional conditions such as natural disasters or employer misinformation.

Part B Immunosuppressive Drug Coverage Enrollment

CMS-10798 · CMS

Application for Part B immunosuppressive drug coverage for individuals who lose Part B but need ongoing immunosuppressive drug coverage after a kidney transplant.

Medicare Advantage Enrollment

Plan-specific (CMS model template) · CMS

Model enrollment form for Medicare Advantage or Part D prescription drug plans. Plans customize the CMS template but must include all required elements.

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