US · guidance
CMS Pub. 100-01, ch. 2, § 40.9.8
Procedure for Termination of Part B-ID
Individuals enrolled in the Part B-ID benefit can report other coverage and request to
terminate their enrollment by either:
1. calling SSA at 1-877-465-0355 to disenroll over the phone to verbally request
termination, or
2. completing and submitting Form CMS-1763, Request for Termination of
Premium Hospital and/or Supplementary Medical Insurance, and mailing it to:
SOCIAL SECURITY ADMINISTRATION
OFFICE OF CENTRAL OPERATIONS
PO Box 32914
BALTIMORE, MARYLAND 21298
3. any other request to SSA that shows the unequivocal desire to end coverage.
Note: The Office of Central Operations Office of Disability Operations teleservice
center (ODO TSC) only will handle the telephonic disenrollment and PC 7 will
process the disenrollment for Part B-ID.
When the individual is reporting other coverage and choosing a future termination date, a
termination effective date that is more than 6 months in the future cannot be processed
History
(Rev. 11764; Issued 12-22-22; Implementation: 01-01-2023; Effective 01-03-23)
Provenance
- Source
- cms.gov
- Retrieved
- 2026-08-25
- Edition
- iom-2026-08-25
- Content hash
11737909013bae39cd8c9360b67df7f36ec5f00113233d30e96e5e6901ef0dd5
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