Medicare Forms

Enrollment Forms

Application for Enrollment in Medicare – Part B (CMS-40B)

This form is used when you’re ready to enroll in Medicare Part B (Medical Insurance). If you’re already enrolled in Part A (Hospital Insurance), and you want to add Part B during a Special Enrollment Period, you’ll need this form.
Use it when:

• You’re leaving employer coverage.
• You delayed Part B and are now ready to enroll.
• Download CMS-40B_508-enabled

Request for Employment Information (CMS-L564)

If you’re applying for Medicare during a Special Enrollment Period due to loss of group health plan coverage from active employment, this form is required to show you had coverage. It’s typically submitted along with the CMS-40B.

Use it when:

• You delayed Medicare because you had employer or union coverage.
• You’re enrolling during a Special Enrollment Period after losing that coverage.
• Download CMS-L564 – 9-23 (1)

Sign Up for Part A and/or Part B Using a Special Enrollment Period

Application for Medicare Part A & Part B – Special Enrollment Period (CMS-10797)
This form is for individuals who qualify for a Special Enrollment Period (SEP) under exceptional conditions—such as FEMA-declared disasters, misinformation from a federal employee, or other unique circumstances.

Use it when:

• You missed your Initial Enrollment Period for reasons outside your control.
• You’re applying under an SEP due to exceptional conditions.
• Download CMS-10797-508C

Application for Enrollment in Part B Immunosuppressive Drug Coverage (CMS-10798)

Use this form if you lost full Medicare coverage but still need Part B coverage for immunosuppressive drugs after a kidney transplant. This benefit began in 2023 and is specific to people who are no longer eligible for full Medicare but still require ongoing medication.

Use it when:

• You’ve had a kidney transplant and lost other Medicare coverage.
• You only need Part B for immunosuppressive drug therapy.
• Download CMS-10798-Fillable enabled 508-final

How to Submit Medicare Forms

• Online: Many forms can be submitted via your MyMedicare.gov account or the SSA website.
• Mail your completed forms to your local Social Security office.
• Visit your nearest Social Security office to submit in person (appointment recommended).

Need Help?

If you’re unsure which form you need or how to complete it, assistance is available:

• Call Medicare: 1-800-MEDICARE (1-800-633-4227)
• Visit Medicare.gov: https://www.medicare.gov
• Social Security: https://www.ssa.gov

Keeping these forms on hand and understanding when to use them can make your Medicare journey smoother and less stressful. Whether you’re transitioning from employer coverage or facing a special circumstance, the right paperwork ensures you get the coverage you need—when you need it.