Information page
What Part B-ID covers, when it can be signed up for and when it starts, the mailing address, help phone numbers and where to get the form in another format.
CMS-10798
Application for Enrollment in Part B Immunosuppressive Drug Coverage
- Agency
- CMS
- Revision
- 12/2025
- Fillable fields
- 32
- Pages
- 3
- Official source
- CMS form page
- Checked
- October 20, 2026
Form CMS-10798: Application for Medicare Part B Immunosuppressive Drug Coverage
Form CMS-10798 is the Application for Medicare Part B Immunosuppressive Drug Coverage from the Centers for Medicare & Medicaid Services. The form says it is for people who only have Medicare because of End-Stage Renal Disease (ESRD) and who lost, or will be losing, their Medicare coverage after a kidney transplant. It describes Part B-ID as coverage that helps pay for immunosuppressive drugs beyond 36 months after a kidney transplant, and says it covers only those drugs and no other items or services.
The one page application asks for a Social Security Number or Medicare Number, name, addresses and phone number. The applicant attests to not having certain other coverage, answers whether they will notify Social Security within 60 days of getting such coverage, and signs. The form says Part B-ID has a monthly premium and an annual deductible. It does not list amounts.
The completed, signed form is mailed to the Social Security Administration address printed on it, and the form says Part B-ID can also be applied for by phone. You can fill it out free in your browser on this page and download the result without an account.
What's on Form CMS-10798
Identification
Social Security Number or Medicare Number, if the applicant has one, and first, middle and last name and suffix.
Addresses and contact
Home address (left blank if there is none), mailing address if different, phone number and an optional email address, with a box authorizing Social Security and Medicare to send emails about benefits and coverage.
Coverage attestation
A statement that the applicant has no Employer Group Health Plan or Individual Health Plan, no TRICARE for Life, no Medicaid or CHIP that includes immunosuppressive drugs, and no VA enrollment or eligibility for those drugs from the VA.
60 day notice question
A Yes or No answer to whether the applicant will notify Social Security within 60 days of obtaining any of the excluded coverages.
Signatures
A statement about false statements, with the text of 18 U.S. Code 1035 in a footnote, then the signature and date signed (mm/dd/yyyy), plus a witness block for a signature by mark.
An information page comes before the one page application, followed by a page with the mailing address, Privacy Act and PRA statements.
How to fill out and send Form CMS-10798
- 1
Read the information page
It says who Part B-ID is for, what it covers, when it starts and that it has a monthly premium and an annual deductible.
- 2
Enter identification
Enter the Social Security Number or the Medicare Number, then the full name.
- 3
Add addresses and contact details
Enter a home address or leave it blank if there is none, a mailing address if different, a phone number and, optionally, an email address.
- 4
Complete the attestation
Read the list of excluded coverage and answer Yes or No to the question about notifying Social Security within 60 days.
- 5
Sign and date
Sign and enter the date. A form signed by mark (X) also needs a witness's name, signature and date.
- 6
Mail it to Social Security
The form says to mail the completed, signed form to Social Security Administration, Office of Central Operations, PO Box 32914, Baltimore, Maryland 21298.
Why fill Form CMS-10798 on indox
You get the real form, filled in a browser tab, with nothing standing between you and the finished PDF.
- Fill the form right in your browser, no software to install
- Free to fill and free to download, with no account
- The official blank straight from the CMS, not a copy someone retyped
- Works on a phone, tablet or computer
Where it goes, costs and help
Where to send it
Social Security Administration, Office of Central Operations, PO Box 32914, Baltimore, Maryland 21298. The CMS address in the PRA statement is for comments on the form only, and the form says not to send applications there.
Applying by phone
The form says Part B-ID can also be applied for by calling 1-877-465-0355 (TTY 1-800-325-0778).
When coverage starts
The form says enrolling before Medicare coverage ends starts Part B-ID the month after Medicare ends. Enrolling after Medicare ends starts it the month after enrollment.
Premium and deductible
The form says there is a monthly premium and an annual deductible for Part B-ID. It does not list amounts and points to Medicare.gov/basics/end-stage-renal-disease for more information.
Help with the form
Social Security: 1-800-772-1213, TTY 1-800-325-0778, with Spanish service by pressing 2. In person help is at local Social Security offices (SSA.gov/locator), and free counseling from your State Health Insurance Assistance Program at shiphelp.org.
Time to complete
The form estimates an average of 10 minutes per response. Medicare information in large print, braille or audio is available through 1-800-MEDICARE (1-800-633-4227), TTY 1-877-486-2048.
Related forms
CMS-43
Application for Part A (Hospital Insurance) and Part B (Medical Insurance) for People with End-Stage Renal Disease
155 fields, 6 pages
CMS-40B
Request for Enrollment in Medicare Part B (Medical Insurance)
47 fields, 3 pages
CMS-10797
Application For Medicare Part A and Part B Special Enrollment Period (Exceptional Circumstances)
72 fields, 6 pages
CMS-18-F-5
Application for Medicare Part A (Hospital Insurance)
127 fields, 7 pages
CMS-1763
Request for Termination of Premium Hospital Insurance of Supplementary Medical Insurance
29 fields, 2 pages
CMS-10106
1-800-Medicare Authorization to Disclosure Personal Health Information
44 fields, 3 pages
Who uses Form CMS-10798?
The form's first page says who it is for and when it can be used.
Official sources and the blank
Do it all with indox
No tool matches that search.
Questions about Form CMS-10798
Who can use Form CMS-10798?
The form says it is for people who only have Medicare because of End-Stage Renal Disease and lost, or will be losing, their Medicare coverage after a kidney transplant. It also says Part B-ID is only for people without certain other coverage, like a group health plan, TRICARE, or Medicaid that covers immunosuppressive drugs.
Where do I mail Form CMS-10798?
The form gives Social Security Administration, Office of Central Operations, PO Box 32914, Baltimore, Maryland 21298.
Can I apply for Part B-ID by phone?
The form says yes, by calling 1-877-465-0355. TTY users can call 1-800-325-0778.
When does Part B-ID coverage start?
The form says it can be signed up for anytime. Enrolling before Medicare coverage ends starts Part B-ID the month after Medicare ends; enrolling after starts it the month after enrollment.
What does Part B-ID cover?
The form says it helps pay for immunosuppressive drugs beyond 36 months after a kidney transplant, covers only those drugs and no other items or services, and isn't a substitute for full health coverage.
Does Part B-ID cost anything?
The form says there is a monthly premium and an annual deductible. It does not list amounts.
What if I get other coverage after enrolling?
The form asks a Yes or No question: whether you will notify Social Security within 60 days of obtaining any of the excluded coverages it lists.