Social Security Medicare Part A Application Form

Visit your local social security office.

Social security medicare part a application form.

Or return the forms by mail to your local social security office. You may complete the forms online by visiting the apply for medicare part b online during a special enrollment period webpage. Or one of its territories you can also contact your nearest u s. You can help by being ready to provide the information and.

Many forms must be completed only by a social security representative. Call social security at 1 800 772 1213 tty. Part a also pays for some home health care and hospice care. It begins 3 months before your 65th birthday or 25th month of disability and ends 3 months after you reach 65 or 3 months.

Fax them to 1 833 914 2016. If you do not have part a do not complete this form. Contact social security if you want to apply for medicare for the first time. The form you are looking for is not available online.

If you are already enrolled in medicare part a and you want to enroll in part b please complete form cms 40b application for enrollment in medicare part b medical insurance. If you are applying for medicare part b due to a loss of employment or group health coverage you will also need to complete form cms l564 request for employment. Get this form and instructions in spanish. Social security office u s.

If you worked for a railroad call the rrb at 1 877 772 5772. Call us at 1 800 772 1213 tty 1 800 325 0778. Visit faq ssa gov or call social security toll free at 1 800 772 1213 for more information. Please call us at 1 800 772 1213 tty 1 800 325 0778 monday through friday between 8 a m.

Medicare part a hospital insurance helps pay for inpatient care in a hospital or limited time at a skilled nursing facility following a hospital stay. Or by calling our national toll free service at 1 800 772 1213 tty 1 800 325 0778 or visiting your local social security office. An appointment is not. If you do not live in the u s.

Social security enrolls you in original medicare part a and part b. You can also fax your enrollment forms and evidence of employment to 1 833 914 2016. Call ahead to make an appointment. Your iep lasts for 7 months.

If you already have part a and want to sign up for part b complete an application for enrollment in part b cms 40b. If you have questions please contact social security at 1 800 772 1213 tty 1 800 325 0778. If you don t already have part a you can apply online at ssa gov benefits medicare. You can complete an application for retirement spouse s medicare or disability benefits online.

Or contact your local social security office. Social security is authorized to collect your information under sections 1836 1840 and 1872 of the social security act as amended 42 u s c. Medicare at any age.