Resources
Medicare Part B
Medicare Part B application forms
If you are enrolling in Medicare Part B after your Initial Enrollment Period — usually because you stayed on an employer group health plan past 65 — Social Security needs two forms. Download them here, or bring them to our Chula Vista office and we will complete them with you.
Download the forms
- CMS-40B — Application for Enrollment in Medicare Part B. This is the form that actually enrolls you.
- CMS-L564 — Request for Employment Information. Section B is completed and signed by your employer or their HR department, and it is what proves you had group health coverage based on active employment.
How to file them
Both forms go to Social Security together. You can upload them through your my Social Security account, fax or mail them to your local office, or bring them in person. Keep a copy of everything and note the date you submitted — it establishes your Special Enrollment Period.
Timing you should not miss
When employment-based coverage ends, you have an eight-month Special Enrollment Period to take Part B without a late penalty. COBRA and retiree coverage do not extend it — the clock starts when the active employment ends. Filing early means Part B starts the month you ask for, instead of leaving a gap.
For 2026 the standard Part B premium is $202.90 per month with a $283 annual deductible. If your income is above $109,000 filing individually or $218,000 filing jointly, an income-related adjustment applies on top.
Hablamos español
¿Necesita inscribirse en la Parte B de Medicare después de dejar el seguro de su trabajo? Le ayudamos a llenar los formularios CMS-40B y CMS-L564 en español y a entregarlos a tiempo al Seguro Social. Llámenos al (619) 361-3591.
Talk to a licensed agent in Chula Vista
Call (619) 361-3591, email info@zulemamedicare.com, or stop by our office at 31 Third Ave, Chula Vista, CA 91910. We are open Monday through Friday, 9:00am to 5:00pm.
We do not offer every plan available in your area. Any information we provide is limited to those plans we do offer in your area. Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Assistance Program (HICAP in California, 1-800-434-0222) to get information on all of your options.
