If you currently have employer health insurance (or have had it within the last 8 months), you will need to:
1. Complete a Medicare Part B application.
2. Have your employer complete the Medicare Employer Verification form.
You can do either #1 or #2:
1. Download the Medicare Part B application and the Medicare Employer Verification from below. Fill-out the Medicare Part B application and have your employer fill out the Employer Verification Form and return to you. Then fax, mail or bring them to your local Social Security Office. (link below to find Social Security office info).
2. Click here to sign-up for Medicare Part B and ALSO upload the completed Medicare Employer Verification Form with this application
Always keep originals. Also write at the top of your Medicare Part B Application “Effective date: May 1, 2023” (the date you wish to begin).
It is highly recommended that you call your local Social Security office about 3 days after you have faxed your paperwork to verify that they have received all of your documents. The phone number can be found on the link below for your local Social Security office.
*Reminder that you will need 2 Employer Verification forms if your spouse is signing up as well.