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INITIAL, LAST NAME) d. Enter your Social Security Number a. Enter your date of birth (Month, day, year) b. Enter name of State or foreign country where you were born Female / / Yes No Unknown If you have not submitted proof of your age complete (c) and (d). c. Was a public record of your birth made before you were age 5? Male 2. c. Enter your sex (check one) Yes No Unknown Yes.

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The Centers for Medicare and Medicaid Services (CMS) provides health coverage to more than 100 million people through Medicare, Medicaid, the Children's Health Insurance Program, and the Health Insurance Marketplace.

The Centers for Medicare & Medicaid Services (CMS) is a Federal agency within the U.S. Department of Health and Human Services. Many CMS program related forms are available in Portable Document Format (pdf).

The CMS-1500 claim form is used to submit non-institutional claims for health care services to many private payers, Medicare, Medicaid and other government health insurance programs. (Most institution-based claims are submitted using a UB-04 form.)

CMS-L40D Only beneficiaries who receive the general enrollment period (GEP) mailing from CMS can use Form CMS-L40D to enroll in SMI during the GEP. CMS mails Form CMS-L40D to individuals that refused, withdrew, or terminated SMI during the prior year. The beneficiary completes the Form CMS-L40D and sends it to CMS.

Is CMS the same as Medicare? No. The Centers for Medicare & Medicaid Services (CMS) is part of the U.S. Department of Health and Human Services (HHS) and is not the same as Medicare. Medicare is a federally run government health insurance program, which is administered by CMS.

You can apply online or you can mail your completed CMS 40B, Application for Enrollment in Medicare - Part B (Medical Insurance) to your local Social Security office.

The federal agency that oversees CMS, which administers programs for protecting the health of all Americans, including Medicare, the Marketplace, Medicaid, and the Children's Health Insurance Program (CHIP).

In person: Your local Social Security office. For an office near you check .ssa.gov.

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© Copyright 1997-2025
airSlate Legal Forms, Inc.
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Form Packages
Adoption
Bankruptcy
Contractors
Divorce
Home Sales
Employment
Identity Theft
Incorporation
Landlord Tenant
Living Trust
Name Change
Personal Planning
Small Business
Wills & Estates
Packages A-Z
Form Categories
Affidavits
Bankruptcy
Bill of Sale
Corporate - LLC
Divorce
Employment
Identity Theft
Internet Technology
Landlord Tenant
Living Wills
Name Change
Power of Attorney
Real Estate
Small Estates
Wills
All Forms
Forms A-Z
Form Library
Customer Service
Terms of Service
DMCA Policy
About Us
Blog
Affiliates
Contact Us
Privacy Notice
Delete My Account
Site Map
All Forms
Search all Forms
Industries
Forms in Spanish
Localized Forms
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
airSlate workflows
DocHub
Instapage
Social Media
Call us now toll free:
1-877-389-0141
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232