Get What Do I Do With The Form - Secure Ssa

This guide provides essential instructions on completing the WHAT DO I DO WITH THE FORM - Secure SSA. Following these steps will help ensure that you properly fill out the form required for Medicare enrollment during a Special Enrollment Period.

Follow the steps to successfully complete the form.

1. Click 'Get Form' button to obtain the form and open it in the editor. This action allows you to access the necessary document for your Medicare enrollment.
2. In Section A of the form, fill out your information as the individual applying for Medicare. Start by providing your employer's name, date, and address. Then, enter your name and Social Security number, followed by the employee's name and Social Security number if applicable.
3. Once you complete Section A, provide the form to your employer. They will be responsible for filling out Section B with details regarding your group health plan coverage.
4. In Section B, your employer will indicate whether you are (or were) covered under an employer group health plan, the starting date of your coverage, and if the coverage has ended. They also need to provide employment dates and signature as a company official.
5. After the employer completes Section B, ensure they sign and date the form before returning it. You'll need to submit this completed form along with your Application for Enrollment in Medicare (CMS-40B) to your local Social Security office.

Ensure your Medicare application is complete by filling out the necessary documents online.