Social Security Medicare Part A Application Form

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.

Social security medicare part a application form.

If you have questions please contact social security at 1 800 772 1213 tty 1 800 325 0778. 1395o 1395s and 1395ii for your enrollment in medicare part b. Part a also pays for some home health care and hospice care. An appointment is not.

Visit your local social security office. Call ahead to make an appointment. You can help by being ready to provide the information and. 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.

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. 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. You can also fax your enrollment forms and evidence of employment to 1 833 914 2016. If you don t already have part a you can apply online at ssa gov benefits medicare.

Social security enrolls you in original medicare part a and part b. Visit faq ssa gov or call social security toll free at 1 800 772 1213 for more information. The form you are looking for is not available online. If you do not live in the u s.

Many forms must be completed only by a social security representative. If you do not wish to use the online application or the application for the benefit you want is not available online you can. Medicare at any age. If you do not have part a do not complete this form.

It begins 3 months before your 65th birthday or 25th month of disability and ends 3 months after you reach 65 or 3 months. Or contact your local social security office. Your iep lasts for 7 months. Visit your local social security office.

Or return the forms by mail to your local social security office. You can complete an application for retirement spouse s medicare or disability benefits online. Get this form and instructions in spanish. Social security office u s.

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. Fax them to 1 833 914 2016. If you already have part a and want to sign up for part b complete an application for enrollment in part b cms 40b. You may complete the forms online by visiting the apply for medicare part b online during a special enrollment period webpage.

Please call us at 1 800 772 1213 tty 1 800 325 0778 monday through friday between 8 a m. Call social security at 1 800 772 1213 tty. Or one of its territories you can also contact your nearest u s.