Find official Medicare and Social Security forms for Part B enrollment, employer coverage, appeals, reimbursement, authorizations, IRMAA reviews, and Extra Help.
These forms are often needed when enrolling in Part B after employer coverage or when asking Social Security to end premium Medicare coverage.
CMS-40B and CMS-L564 are commonly submitted together when requesting a Part B Special Enrollment Period. Social Security determines whether you qualify.
Use this application to enroll in Medicare Part B when you already have Part A or when Social Security tells you to submit a paper application.
This form documents group health coverage based on current employment. The employer generally completes Section B.
Many people can apply online for Medicare through Social Security instead of mailing a paper application.
Use the instructions on your Medicare Summary Notice or decision letter. Filing addresses and deadlines depend on the specific claim or appeal.
This form may be used to ask Original Medicare to pay for a covered service when a provider or supplier did not submit the claim.
Use this form for the first level of appeal when you disagree with an Original Medicare coverage or payment decision.
Giving someone permission to receive information is not always the same as appointing that person to formally act for you in an appeal.
Use this form to appoint a person to act on your behalf in a Medicare claim, appeal, grievance, or related matter.
Use this authorization when you want Medicare to share your personal health information with a person or organization you name.
These requests are handled by Social Security rather than by a Medicare insurance carrier.
Use this form to ask Social Security to reconsider an IRMAA determination after a qualifying life-changing event that reduced your income.
Use this application to request Extra Help with Medicare Part D premiums, deductibles, and prescription copayments.
Match the form to your situation and verify that it is the current official government version.
Attach employer verification, itemized bills, decision notices, tax documents, or other required evidence.
Keep copies, confirmation numbers, certified-mail receipts, upload confirmations, or fax transmission reports.
Browse enrollment, appeal, claim, authorization, payment, and other forms maintained by Medicare.
Browse Medicare Forms ↗Locate a nearby Social Security office or review available online and telephone services.
Find an SSA Office ↗A licensed Accurate Health Plans agent can explain general Medicare enrollment steps and help you understand how your coverage choices may work together.