Enrollment
Know what the Part B enrollment form is for, and where your completed application belongs.
The supplied Request for Enrollment in Medicare Part B is for people who already have Part A and want to enroll in Part B during an applicable enrollment period. If you do not have Part A, contact Social Security about first-time Medicare enrollment.
If your enrollment relates to employer or union coverage since age 65, employment and coverage dates may be needed. The form instructions call for your employer to complete CMS-L564 where applicable.
Follow the application instructions to mail or fax your completed, signed form to your local Social Security office. Find the office at SSA.gov/locator. Do not send your Medicare number, completed application or health information through this website.
General education only, not a plan recommendation or legal, tax or investment advice. Coverage and enrollment rules depend on individual circumstances. Source handouts with amounts are labeled for 2026; consult Medicare.gov and Social Security for current information. Do not send completed forms or sensitive identification information through this website.