Individuals residing in foreign countries entitled to HI who wish to enroll in SMI
during their IEP must complete a Form CMS-40B (Application for Medicare Part B (Medical
This form is available in English and Spanish and can be obtained by calling the Teleservice
Center (TSC), by contacting an U.S. Consular office (or U.S. Veterans Administration
Regional Office in Manila for beneficiaries living in the Philippines) or by downloading the form from Medicare’s website. For exhibits of the Form CMS-40B, see SM 00706.265.
The foreign IEP package offers beneficiaries two ways to obtain Form CMS-40B if they
want to enroll in SMI:
complete Form CMS-1739 and send it using the envelope included in the package, or
download the form from Medicare’s website.
The beneficiary sends Form CMS-1739 to SSA to protect the filing date for the individual
requesting SMI as outlined in HI 00805.075. The beneficiary sends the completed Form CMS-1739 to OIO. Upon receipt of Form CMS-1739,
OIO mails the beneficiary Form CMS-40B along with a return envelope addressed to OIO.
OIO may also contact the beneficiary to offer the availability of the online form,
following instructions HI 00805.110D.1. In all cases, instruct the beneficiary to mail the completed form to OIO.
For enrollments outside the IEP, follow instructions in HI 00805.110B.2.