You can sign up for Medicare Part B online!  If you’re enrolled in Medicare Part A and want to enroll in Part B during the Special Enrollment Period, please visit our Medicare web page at www.ssa.gov/benefits/medicare/.

From there, you can enroll in Part B by completing these forms:  CMS-40B (Application for Enrollment in Medicare – Part B [Medical Insurance]) and CMS-L564 (Request for employment information).

You can also fax or mail the CMS-40B and CMS-L564 to your local Social Security office to enroll.  You can find the fax number and address for your local office at www.ssa.gov/locator.  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 Group Health Plan or Large Group Health Plan.

• 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.