again. Watch this video to find out how to terminate premium hospital and/or supplementary medical insurance. What Is Form CMS-40b? Youll want Part B back eventually. 7500 Security Boulevard, Baltimore, MD 21244, Find a Medicare Supplement Insurance (Medigap) policy. 7500 Security Boulevard, Baltimore, MD 21244, Request for Termination of Premium Hospital Insurance of Supplementary Medical Insurance, An official website of the United States government, CMS Accessibility & Nondiscrimination for Individuals with Disabilities Notice. document.getElementById( "ak_js_1" ).setAttribute( "value", ( new Date() ).getTime() ); With licensed sales professionals in both the investment and insurance fields, the experienced and knowledgeable team at Crowe & Associates can tend to your various needs. Or, find out how to enroll in a Medicare Advantage Plan (Part C). Get Other Forms. Where do I send the SS CMS 1763 form to disenroll from I hold a Law Degree, a BBA, an MBA (Finance Specialization), and CFP & CRPS designations as well I've been providing tax, corporate law & accounting, financial, and Social Security advice to clients on three continents since 1986. At a large employer. To restore Part B when your new employers coverage ends, youll have to take action. 7500 Security Boulevard, Baltimore, MD 21244, Request for Termination of Premium Hospital and Supplementary Medical Insurance, An official website of the United States government. Or call the Social Security Administration at 800-772-1213 to request the form, and youll be told where to send it. A Social Security representative will explain both the procedure and the results of the termination. Learn about the costs for Medicare drug coverage. Find the content you are looking for by entering in search terms below. Call 1-800-772-1213. Create your signature and click Ok. Press Done. lock The termination will usually take place at the end of the month that they file the request. This is a standard Department of Health and Human Services form it is for use by any Medicare enrollee who wants to stop receiving premium hospital (Medicare Part A) and Supplementary Medical insurance (Medicare Part B). Dummies helps everyone be more knowledgeable and confident in applying what they know. But in a specific situation where youre already enrolled in Part B, but then weeks, months, or years later you or your spouse starts a job with health benefits. 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