Medicare Medical Insurance Enrollment
/ What is this form?
Medicare Part B provides medical insurance covering doctor's office visits, outpatient services, preventive care (flu shots, cancer screenings, annual wellness visits), medical equipment, and certain home health services. The standard monthly premium in 2025 is $185, though higher-income beneficiaries pay Income-Related Monthly Adjustment Amounts (IRMAA) surcharges that can more than double the premium.
Approximately 4 million Americans turn 65 each year. While Medicare Part A (hospital insurance) is generally automatic for those who paid Medicare taxes for 40 quarters, Part B requires active enrollment. Failing to enroll during the correct window results in a permanent late enrollment penalty of 10% per year of delay, added to the premium for as long as you have Part B.
CMS-40B is the paper enrollment form used for Part B enrollment outside the Initial Enrollment Period — specifically during the General Enrollment Period (January–March) or a Special Enrollment Period (following loss of qualifying employer coverage). Most people enrolling during IEP can apply online at ssa.gov without a paper form.
/ Who needs this form?
/ What you need before you start
/ Step-by-step guide
/ Key fields explained
| Field | What to enter | Common mistake |
|---|---|---|
| Medicare Claim Number | Your 11-digit Medicare Beneficiary Identifier (MBI) from your red, white, and blue Medicare card. Format: 1 letter, 10 alphanumeric characters (e.g. 1EG4-TE5-MK72). If you don't have a card yet, use your SSN. | Using your old SSN-based claim number if you still have an old red Medicare card — these have been replaced with new MBI cards for all beneficiaries since 2019. |
| Reason for Enrollment | Check the appropriate box: Initial Enrollment Period, General Enrollment Period, or Special Enrollment Period. For SEP, specify the reason: employer/union coverage ended, loss of coverage due to divorce/death, etc. | Checking 'General Enrollment Period' when you should be claiming a Special Enrollment Period — GEP triggers a late penalty, while SEP does not. Always claim SEP if you had qualifying employer coverage. |
| Date Coverage Ended (SEP) | The exact date your qualifying employer or union group health coverage ended. This determines the 8-month SEP window. | Using the date you stopped working rather than the date insurance coverage actually ended — employer coverage often continues through the end of the month of termination. |
/ Common mistakes to avoid
/ Frequently asked questions
Part B covers medically necessary services: doctor visits, outpatient hospital care, lab tests, X-rays, mental health services, durable medical equipment, ambulance services, and preventive services (flu shots, mammograms, colonoscopies, annual wellness visits). Part B covers 80% of approved costs after the annual deductible ($257 in 2025).
$185/month is the standard premium. IRMAA surcharges apply to individuals with income above $103,000 (or $206,000 for couples), ranging up to $628.90/month at the highest income tier.
Yes. The Medicare Savings Program (MSP) can help pay the Part B premium, deductible, and copays for people with limited income and resources. Contact your state Medicaid office to apply.
Medigap (Medicare Supplement Insurance) is private insurance that covers the 20% coinsurance and other costs that Part B doesn't pay. Enrollment in Medigap is easiest during the 6-month Medigap Open Enrollment Period starting when you turn 65 and enroll in Part B. After this period, you may be denied or charged more based on health.