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Fax them to 1 833 914 2016.
Social security medicare part a application form. You can also fax your enrollment forms and evidence of employment to 1 833 914 2016. If you already have part a and want to sign up for part b complete an application for enrollment in part b cms 40b. You can complete an application for retirement spouse s medicare or disability benefits online. Or return the forms by mail to your local social security office.
You may complete the forms online by visiting the apply for medicare part b online during a special enrollment period webpage. If you don t already have part a you can apply online at ssa gov benefits medicare. 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. 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.
Part a also pays for some home health care and hospice care. Call us at 1 800 772 1213 tty 1 800 325 0778. If you do not have part a do not complete this form. If you do not live in the u s.
Or contact your local social security office. Call ahead to make an appointment. The form you are looking for is not available online. You can help by being ready to provide the information and.
Your iep lasts for 7 months. It begins 3 months before your 65th birthday or 25th month of disability and ends 3 months after you reach 65 or 3 months. 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. An appointment is not.
If you worked for a railroad call the rrb at 1 877 772 5772. Social security office u s. Or one of its territories you can also contact your nearest u s. Please call us at 1 800 772 1213 tty 1 800 325 0778 monday through friday between 8 a m.
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. Many forms must be completed only by a social security representative. 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.
Visit your local social security office. Call social security at 1 800 772 1213 tty. Get this form and instructions in spanish. Social security enrolls you in original medicare part a and part b.
Visit your local social security office. Contact social security if you want to apply for medicare for the first time. Visit faq ssa gov or call social security toll free at 1 800 772 1213 for more information.
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