What is Medicare Part B for?

Medicare Part B (medical insurance) helps pay for services from doctors and other health care providers, outpatient care, home health care, durable medical equipment, and some preventive services.

Why do I need Medicare Part B?

You Need Part B if Medicare Is Primary Once you retire and have no access to other health coverage, Medicare becomes your primary insurance. Part A pays for your room and board in the hospital. Part B covers most of the rest. Enrolling in Part B when Medicare is primary will help you avoid unexpected medical bills.

How do I cancel Medicare?

Most people do not pay a premium for Medicare Part A hospital insurance, so there is no mechanism to cancel it in this case. But if you do pay a premium for Part A and wish to cancel it, you may do so by visiting your local Social Security office or by calling 1-800-772-1213 (TTY 1-800-325-0778).

Can I cancel Medicare Part B at any time?

You can voluntarily terminate your Medicare Part B (medical insurance). ... To find out more about how to terminate Medicare Part B or to schedule a personal interview, contact us at 1-800-772-1213 (TTY: 1-800-325-0778) between Monday through Friday from 8:00 am u2013 7:00 pm.

What happens if you decline Medicare Part B?

Welcome to Medicare! NOTE: If you don't get Part B when you are first eligible, you may have to pay a lifetime late enrollment penalty. However, you may not pay a penalty if you delay Part B because you have coverage based on your (or your spouse's) current employment.

How do I submit CMS 1763?

You must submit Form CMS-1763 (not available online) to the Social Security Administration (SSA). Visit or call the SSA (1-800-772-1213) to get this form. You'll need to have a personal interview with Social Security before you can terminate your Medicare Part B coverage.

How do I cancel Medicare?

Most people do not pay a premium for Medicare Part A hospital insurance, so there is no mechanism to cancel it in this case. But if you do pay a premium for Part A and wish to cancel it, you may do so by visiting your local Social Security office or by calling 1-800-772-1213 (TTY 1-800-325-0778).

How do I fill out CMS 1763?

Enrollee Name. Medicare Claim Number. Name of the Person Executing the Request (if appropriate) Determination of the coverage requiring termination. If you want to opt-out of both coverages, check them. End Date of the Insurance. Reasons for the termination request. Signature. Address.

Can you disenroll from Medicare Part B?

You can voluntarily terminate your Medicare Part B (medical insurance). However, since this is a serious decision, you may need to have a personal interview. A Social Security representative will help you complete Form CMS 1763. ... You can also contact your nearest Social Security office.

What happens if you don't sign up for Medicare Part B?

In most cases, if you don't sign up for Medicare Part B when you're first eligible, you'll have to pay a late enrollment penalty. You'll have to pay this penalty for as long as you have Part B and could have a gap in your health coverage.

Get CMS-1763 1997

Q: What happens if you decline Medicare Part B?

Welcome to Medicare! NOTE: If you don&#039;t get Part B when you are first eligible, you may have to pay a lifetime late enrollment penalty. However, you may not pay a penalty if you delay Part B because you have coverage based on your (or your spouse&#039;s) current employment.

Q: What happens if you don&#039;t sign up for Medicare Part B?

In most cases, if you don&#039;t sign up for Medicare Part B when you&#039;re first eligible, you&#039;ll have to pay a late enrollment penalty. You&#039;ll have to pay this penalty for as long as you have Part B and could have a gap in your health coverage.

SIGNATURE Write in Ink 1. NAME OF WITNESS SIGN HERE ADDRESS MAILING ADDRESS Number and Street City State and Zip Code CITY STATE ZIP CODE DATE Month Day and Year Form CMS-1763 05/97 TELEPHONE NUMBER. Form Approved OMB No* 0938-0025 DEPARTMENT OF HEALTH AND HUMAN SERVICES CENTERS FOR MEDICARE MEDICAID SERVICES REQUEST FOR TERMINATION OF PREMIUM HOSPITAL AND/OR SUPPLEMENTARY MEDICAL INSURANCE DO NOT WRITE IN THIS SPACE The completion of this form is needed to document your voluntary request for termination of Medicare coverage as permitted under the Code of Federal Regulations. Section 1838 b and 1818A c 2 B of the Social Security Act require filing of notice advising the Administration when termination of Medicare coverage is requested* While you are not required to give your reasons for requesting termination the information given will be used to document your understanding of the effects of your request. NAME OF ENROLLEE Please Print NAME OF PERSON IF OTHER THAN ENROLLEE WHO IS EXECUTING THIS REQUEST. MEDICARE CLAIM NUMBER THIS IS A REQUEST FOR TERMINATION OF HOSPITAL INSURANCE MEDICAL INSURANCE DATE SUPPLEMENTARY WILL END DATE HOSITAL INSURANCE I request termination of my enrollment under the above sections of title XVIII of the Social Security Act as amended for the reason s stated below I UNDERSTAND THAT IF I AM REQUIRED TO PAY FOR MY HOSPITAL INSURANCE THE TERMINATION OF MY SUPPLEMENTARY MEDICAL INSURANCE COVERAGE WILL ALSO END MY HOSPITAL INSURANCE COVERAGE* According to the Paperwork Reduction Act of 1995 no persons are required to respond to a collection of information unless it displays a valid OMB control number. The valid OMB control number for this information collection is 0938-0025. The time required to complete this information collection is estimated to average 25 minutes per response including the time to review instructions search existing data resources gather the data needed and complete and review the information collection* If you have any comments concerning the accuracy of the estimate s or suggestions for improving this form please write to CMS Attn PRA Reports Clearance Officer 7500 Security Boulevard Baltimore Maryland 21244-1850. If this request has been signed by mark X two witnesses who know the applicant must sign below giving their full addresses. Form Approved OMB No* 0938-0025 DEPARTMENT OF HEALTH AND HUMAN SERVICES CENTERS FOR MEDICARE MEDICAID SERVICES REQUEST FOR TERMINATION OF PREMIUM HOSPITAL AND/OR SUPPLEMENTARY MEDICAL INSURANCE DO NOT WRITE IN THIS SPACE The completion of this form is needed to document your voluntary request for termination of Medicare coverage as permitted under the Code of Federal Regulations. Section 1838 b and 1818A c 2 B of the Social Security Act require filing of notice advising the Administration when termination of Medicare coverage is requested* While you are not required to give your reasons for requesting termination the information given will be used to document your understanding of the effects of your request. .

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