Fill and sign Form CMS-40B online
Enrolls you in Medicare Part B if you already have Medicare Part A.
Form CMS-40B at a glance
- Official name
- Request for Enrollment in Medicare Part B (Medical Insurance)
- Issued by
- Centers for Medicare & Medicaid Services
- Country
- United States
- Category
- Health
- Language
- English
- Who uses it
- People who have Part A and want to add Part B, for example when leaving employer group health coverage.
- Signature
Check with the recipient
Not stated whether an electronic signature is accepted. The applicant signs and dates the form; anyone who signs with a mark needs a witness.
Form CMS-40B is the request to enroll in Medicare Part B (medical insurance) for people who already have Part A. It is often used when you leave a job-based health plan after 65. Open the official form from cms.gov in BunnyDoc's free Sign PDF tool straight from this page, type into its fillable fields, add your signature and date, and download it. Everything runs in your browser, so the PDF never leaves your device.
How to fill in and sign Form CMS-40B
Check you have Part A
Use CMS-40B only if you already have Medicare Part A. If you do not, contact Social Security to apply for Medicare.
Open the current form
Use the button on this page to open cms40b-e.pdf from cms.gov in Sign PDF.
Section 1: basic information
Enter your Medicare number, full name, mailing address, phone number and email address.
Section 2: enrollment in Part B
Say whether you have had employer or union group health coverage, or certain volunteer coverage, since 65, with the dates. If you are enrolling while still covered at work, choose when Part B should start.
Section 3: sign and date
Sign and date the form. If you sign with a mark, a witness who knows you must also sign.
Send it to Social Security
Fax or mail the form to your local Social Security office, found at SSA.gov/locator. If you used a Special Enrollment Period, include Form CMS-L564 completed by your employer.
What you need before you start
- Your Medicare number.
- Dates of your or your spouse's employment and group health coverage since 65.
- Form CMS-L564 filled in by the employer, if you are enrolling in a Special Enrollment Period.
Online, fax or mail?
Social Security's Part B only page says that if your employer coverage ended within the last 8 months you can apply online. Otherwise fax or mail Form CMS-40B, with Form CMS-L564 if needed, to your local office. Coverage generally starts the month after you sign up, so apply promptly to avoid gaps and late enrollment penalties.
Common mistakes
- Using CMS-40B when you do not yet have Part A.
- Leaving out Form CMS-L564 when you rely on employer coverage.
- Missing the 8-month Special Enrollment Period after coverage ends.
Form CMS-40B: frequently asked questions
Where do I send Form CMS-40B?
Fax or mail it to your local Social Security office. You can find it at SSA.gov/locator.
Can I sign up for Part B online instead?
Yes, if you are in the Special Enrollment Period after employer coverage that ended within the last 8 months. Social Security's Part B page has the link.
When is the General Enrollment Period?
The form lists it as 1 January to 31 March each year, for people who missed their other enrollment periods.
What is Form CMS-L564?
It is the Request for Employment Information that your employer completes to confirm your group health coverage, so you can avoid a late enrollment penalty.
Can I sign Form CMS-40B electronically?
CMS and SSA do not say whether an electronic signature is accepted on the paper form. If you are unsure, print it and sign by hand, or use the online application if you qualify.
Is BunnyDoc connected to Medicare?
No. BunnyDoc is not affiliated with Medicare, CMS or the Social Security Administration. We link to the official form on cms.gov and give you a free tool to fill and sign it in your browser.
BunnyDoc is not affiliated with Centers for Medicare & Medicaid Services. Check that the recipient accepts electronic signatures.
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