Get Medicare Form

This form is your application for Medicare Part B (Medical Insurance). You can use this form to sign up for Part B: During your Initial Enrollment Period (IEP) when you're first eligible for Medicare. During the General Enrollment Period (GEP) from January 1 through March 31 of each year.

Voluntary Termination of Medicare Part B You must submit Form CMS-1763 (PDF, Download Adobe Reader) to the Social Security Administration (SSA). Visit or call the SSA (1-800-772-1213) to get this form. You'll need to have a personal interview with Social Security before you can terminate your Medicare Part B coverage.

This form is your application for Medicare Part B (Medical Insurance). You can use this form to sign up for Part B: During your Initial Enrollment Period (IEP) when you're first eligible for Medicare. During the General Enrollment Period (GEP) from January 1 through March 31 of each year.

Medicare. Call 1-800-MEDICARE (1-800-633-4227) to ask for a copy of your IRS Form 1095-B.

Medicare is sending a Form 1095-B to people who had Medicare Part A coverage for part of <year>. The Affordable Care Act requires people to have health coverage that meets certain standards, also called qualifying health coverage or minimum essential coverage.

The Centers for Medicare & Medicaid Services (CMS) is a Federal agency within the U.S. Department of Health and Human Services. Many CMS program related forms are available in Portable Document Format (pdf).

To sign up for Part B in one of these situations, you'll also need to fill out and submit an Application for Enrollment in Part B (CMS-40B) form at the same time.

This form is used for proof of group health care coverage based on current employment. This information is needed to process your Medicare enrollment application. The employer that provides the group health plan coverage completes the information about your health care coverage and dates of employment.