Medicare Enrollment Application – Who Has to Apply?

Medicare is a health insurance program provided by the United States government.  The Medicare Program covers citizens who are 65 years old or older, or those meeting other specific criteria.

The Medicare program is administered by the Centers for Medicare and Medicaid Services (CMS) department.  In order for you to take advantage of Medicare, and for your physician to accept your coverage, you must both complete a Medicare application.

Medicare coverage and information is subject to change without notice.  You should always check with your local Social Security agency before relying solely on this article.

Individual Coverage

Most people qualify for Medicare when they reach 65 years old or if certain medical conditions apply.  Anyone already receiving Social Security benefits will automatically enrolled in Medicare Parts A and B. Because you must pay a premium for Part B coverage, you have the choice not to include Part B coverage on your Medicare application.  Persons who are automatically eligible will be notified several months prior to their eligibility birthdate with the proper information.

Individuals who are not automatically enrolled must complete the Medicare application CMS 40B, Application for Enrollment in Medicare.  To obtain this form, you must either visit your local Social Security Administration office or arrange for a Medicare application appointment at 1-800-772-1213.

For convenience, an application for monthly benefits for retirement, disability, or a spouse is often submitted with the Medicare application.  It is possible to apply for these monthly benefits online at www.socialsecurity.gov/applyforbenefits  Your local Social Security office can also help you with this application.

Provider Coverage

Medical providers desiring to participate in the Medicare health insurance program must submit a Medicare application. One example applicable to doctors, hospitals, and ambulance is Form CMS 10115, Section 1011 Provider Enrollment Application.  This relatively short form requires basic contact information as well as the applicant’s Medicare Identification Number, Federal Tax Identification Number, and, for hospitals only, lists of physicians with hospital privileges and their provider numbers.

Examples of a Medicare application for different providers include:

Form CMS 855A, Medical Enrollment Application – Institutional Providers
applies to: Community Mental Health Centers, Comprehensive Outpatient
Rehabilitation Facilities, Critical Access Hospitals, End-Stage Renal Disease Facilities, Federally Qualified Health Centers, and other facilities specifically listed on the application.  This Medicare application is available for download from http://www.cms.hhs.gov/cmsforms/downloads/cms855a.pdf

Form CMS 855B is entitled Medicare Enrollment Application – Clinics/Group Practices and Certain Other Suppliers.  It applies to Ambulance Service Suppliers, Ambulatory Surgical Centers, Clinic/Group Practices, Independent Clinical Laboratories, and other facilities specifically listed on the application.  It is available for download from http://www.cms.hhs.gov/CMSforms/downloads/cms855b.pdf

The Beginning of the Medicare Paper Trail

There are many more Medicare application forms available than can be discussed or even listed here.  Whether you are a doctor or a patient, the enrollment process begins with the Medicare application.

177 Responses to Medicare Enrollment Application – Who Has to Apply?

  • Gilda Ramos says:

    I will be 65 in November 2011 . I do not have health Ins But I am employed and would like to continue working and would like
    to enrolled in m/care . Do I qualify ? for part a and part b
    and part d and how much since I wish to work would the part b and d cost me and how do I pay for this? Since I do not want to file for soical secuity till I am a full age to take it at age 66 , Also I have no insurance will pre/x apply when I enroll.

    Thank you Very much

    Gilda Ramos

  • Many of you may have had problems with your Part D Drug plans..remember, prior to 2006 there was not drug coverage for people on medicare. But be selective in choosing your plan.

  • carol says:

    my father in law has medical ,medicare and medicaid but h stopped his medical .Does the medicaid will be stopped too or still will be since he’s keeping his medicare.thanks

  • Nan Walker says:

    I was a CA state worker that retired at age 58 due to illness. My HMO is Kaiser Permanente. I am now 61. Late last year (Nov 2010)., I was approved for Social Security Disabilty due to that illness. Am I supposed to change my HMO to a Medicare sponsored Kaiser Plan or what? I have no idea who to call to find out. Thanks for any info!

  • Elena Leal says:

    My dad is 42yrs old a legal us resident he is in early stage Renal Failure and has kidney stones which interfere with his ability to work needs surgery but cant afford it. Is there some try of benefit he can apply to to help him out, maybe medicare.

  • would you please send me application for medicare B

  • J PATEL says:

    i have applied for medicare. How long is it gonna take to be delivered?

  • Angie Office Manager says:

    Hello! We need to know where to submit our provider application for a chiropractor who is licensed and practicing in Oregon. I went to the CMS website and the address is in Indianapolis so I sent the 29 page document there and got back a letter saying I sent it to the WRONG place but they kept the 29 page document! ARG! Now we have to complete it AGAIN.. HELP! Where do I send it?!?!?

  • Martha Castillo says:

    My mother is 63 years old. Can she qualify to get medicare early because she fell and broke a bone of her shoulder. She had to go through prosthetic surgery. My mother’s arm will never be the same. She won’t be able to clean the house, lift objects she will barely be able to comb her hair and that’s if she goes through the therapy.

  • peggy burtwell says:

    I DID NOT WANT TO BE ENROLLED IN THE MEDICARE PROGRAM. PLEASE DEACTIVATE MY ENROLLMENT ASAP. THANK-YOU

  • Joshua says:

    I AM 67 YEARS OLD WITH NO MEDICARE PART B. DO I NEED PART B EVEN THOUGH I AM STILL WORKING.

  • Tom Partridge says:

    I am disabled with ssdi, medicare. My Autistic/MR son qualified for lifetime medicare under “survivorship” – his medicare number is my social security number plus a “c1”. He is 25 years old, and also qualified for medicaid here in CT. He goes to a couple of doctors under medicaid, the rest under medicare only. WE’ve now run into two doctors who accept medicare patients who tell us because my son has medicaid they CANNOT accept him, even if he has medicare and we bring him in as a medicare only patient, paying out of pocket for the balance. CAN THEY REJECT A MEDICARE PATIENT BECAUSE HE ALSO HAS MEDICAID?

  • nanci cole says:

    I am older than my husband.He has eleven years before retirement.I should have had Medicare four years ago but was on my husbands insurance.I was a homemaker and did not pay into social security.He lost his job a year ago.Our Cobra will be out in a month HELP! No one will insure me because of my age and we cannot afford Medicare through the government.We don’t qualify for Medicare, looked into that.

  • Celia F Salazar says:

    I’m 62 yrs. old and start my social security benefit,but I would like to know If I’m eligible to apply for medicaid or medicare.I have highblood and I need to see a doctor .I have no other income and my SS benefit start October 2011.

  • Vania Villa says:

    Hi, I am very worried and want to know if i would be eligible for pregnancy medicaid. I have been in the U.S for 17 years but i just became a permanent resident in June 2011. My husband is a U.S Citizen. Is there a possibility i may be eligible? Or what should i do?

  • e says:

    my father in law has copd and hep c and is under 65yrs, does he qualify for medicaid?

  • jayson blunt says:

    I will be 65 in March and on ss disability. Do I qualify for Medicare. If so what is the application process??

  • Brett says:

    Is their an application window for Medicaid or can a person apply immediately upon losing insurance pursuant to a divorce.

  • Shirley Agatep says:

    my mother-in-law is now 79 years old at the age of 70 she retired from teaching at LAUSD. she worked for 35+ years. when she reired we know she had hmo coverage and medicare. she recently had a slip in fall accident injuring her her hand which required surgery. she somehow lost all her medical coverage and is now uninsured. what do we do to get her medicare coverage back?

  • Lori says:

    My boyfriend is 55 years old with Diabetes. He works full time but has no health insurance. Is he eligible for Medicare? He is ineligible for medicaid. Thank you for your help.

  • mary willis says:

    i turned 65 in dec. 2010. at the time i was working and had coverage for hospital ,office visits ,and medicine. i get part a now. i did not select part b because i had coverage at work. i am now out of work and need part b. how do i apply to have part b . i do receive social security now so i know the premiun would be taken out of my check. how can i get enrolled before enrollment ends in dec.?

  • Steve Thomas says:

    My wife has a birth defect and she can’t get insurance. Can see go on Medicare at 64?

  • charles williams says:

    hi i’m 44 years old with a bad heart condition,seizers,sever migrains,back pains,dizziness and also blackout at times and also have high colesterol and been going to the doctor and scraping up money to pay for all my bills i know i owe my family over thousands of dollars i can’t get help from the medicare/medicaid dept in n.c because they feel i am able to do the maybe they need to live with me to see how it feels.WHAT MUST I DO TO GET HELP!!!!!!!!!!!

  • Sherry says:

    I need to have surgery on my back which there is a chipped bone sitting on the nerve right on the disc of my spine which stays inflammed all the time. This is making me lose my balance always losing the feeling in both legs and hands. Can not afford to pay have no income, I am 44 years of age and have no insurance, how can I get medicare to help me cover for a much needed surgery. Please help with some information on what to do.

  • maria T. says:

    I’m 78 and still work full time. Will I be penelized when I retired for not joining Medicare when I turned 65?

  • Ramachandra K bhat says:

    I and my wife became naturalizd US citizens in 1982. I am still working as a civilian in US Air Force. My mother-in law had a green card ten years ago but she returned to India and then she visited back USA on visitor visa five years ago. Now , if we get my mother in law a green card will she be eligible for Medicare Part A, Part B and Part D?

    Ram Bhat

  • Denise Simon says:

    I am 65 and still working full time with insurance benefits. When do I need to apply for Medicare Insurance.

Leave a Reply

Your email address will not be published. Required fields are marked *



Search Now!

Free Medicare Guide!