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Original Medicare Enrollment: https://www.ssa.gov/medicare/sign-up

Part A and B Enrollment Forms

CMS-18-F-5: Individuals who do not have Part A and wish to enroll should complete the CMS-18-F-5 form or contact Social Security at 1-800-772-1213. This form can be used to enroll in Part B at the same time. If applying for the SEP for the Working aged and Working Disabled, also complete the form CMS-L564.

CMS-40B: Individuals who have Part A, but not Part B, should complete form CMS-40B to enroll in Part B. If applying for the SEP for the Working aged and Working Disabled, also complete the form CMS-L564.

CMS-4040: Individuals who are NOT entitled to social security or railroad retirement board benefits should complete form CMS-4040 to enroll in Part B.

CMS-43: Individuals who have ESRD should complete form CMS-43 to enroll in Part A and Part B.

CMS-10797: Individuals who qualify for a special enrollment period due to exceptional conditions should complete the CMS-10797 to enroll in premium Part A and Part B.

CMS-L564: Individuals who are applying for the SEP for the Working Aged and Working Disabled should complete the form CMS-L564 along with the applicable Part A or Part B enrollment form.

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Virginia Medicare Supplement Open Enrollment Period

Effective January 1, 2024, Virginia is changing its Medicare Supplement regulations to include an open enrollment period for individuals under 65 with end stage renal disease (ESRD) and a premium rate limitation for qualifying disabilities.

§ 38.2-3610 of the Code of Virginia was amended to include:

Open enrollment period is six months beginning the first month in which the under age 65 individual is enrolled in Medicare Parts A and B, and is eligible for Medicare by reason of disability, specifically end-stage renal disease.
Each insurer issuing Medicare supplement policies are required to offer at least one of its issued Medicare supplement policies:
- – Plans A, and D or G for persons new to Medicare on or after January 1, 2020
- – Plans A, and C or F for persons eligible prior to 2020
Prohibits insurers from charging individuals who are under age 65 and eligible for Medicare by reason of any qualifying disability premium rates for any Medicare supplement plan that exceed the premium rates charged for such plan to individuals who are 65.

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What enrollment period should I use? This is the most common question that we get, so here is a helpful guide.

A situation that often arises that agents didn’t know about is where an individual delays Part B and now is ready to retire and enroll. They will use the special election period (SEP) of loss of employee coverage to enroll into the Part B of Original Medicare. But what happens with the enrollment period of the additional Medicare Health Plan?

Medicare Supplement - You have 6 months from the date of Part B.
Part D Prescription Drug Plan - Goes off the Part A effective date, so you have to use SEP (63 days).
Medicare Advantage Plan - IEP (initial election period) or SEP is available. If you want to use IEP you must request an effective date of the MAPD that matches the Part B effective date. If those two dates do not match, and the Part A & B of Original Medicare effective dates are more than 3 months apart, you must use the SEP to enroll into the MAPD.

Election period booklet

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Children can be listed under a parent's Medicare coverage if:

They are under age 18 and have end-stage renal disease (ESRD).
They are between ages 20 and 22 and receive Social Security disability benefits.
They have a parent who receives or is eligible for Social Security retirement benefits.
They have received SSDI benefits for at least 24 months.
They are unmarried and meet other eligibility criteria.

Learn more:

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