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Department of health and human services centers for medicare & medicaid services form approved omb no. Send your completed and signed application to your local social security office. Write the name of your employer. You retired within the last 8 months. Other i want to enroll in part b only.
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You retired within the last 8 months. One portion is completed by you and the other is completed by your employer or your spouse’s employer. Save or instantly send your ready documents. It is used only by those who have their plan covered by the entities where they work. You can also fax your enrollment forms and evidence of employment.
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