فرم CMS-40B: Request for Enrollment in Medicare Part B (Medical Insurance)

Use this form if you already have Medicare Part A and want to sign up for Part B (Medical Insurance). If you don't have Part A, don't complete this application —instead, contact Social Security to apply for Medicare for the first time. Submit your completed and signed form by mail, fax, or by visiting your local Social Security office in person. Find an office near you at SSA.gov/locator. Contact Social Security at 1-800-772-1213 (TTY 1-800-325-0778) with questions.