FormWhen To Use this FormForm NumberLink To Form
Sign up for MedicareIf you’re 65 or older, you can enroll online for Parts A and B, or Part A only. You can delay Part B if you’re already covered through an employer group health plan.Online Form

Application For Enrollment in Medicare Part BTo apply for Medicare Part B which is coverage for Medical Insurance. This forms gets the process started for you and by filling it our during the correct timeframes, you will avoid penalties. Form SSA-40B
Proof of Creditable Coverage When Applying for MedicareTo prove you had creditable health insurance when you sign up for Medicare Part B after age 65. This form makes sure you don’t get a Part B penalty for having a gap in coverage.Form CMS-L564
Enroll in Medicare Easy Pay – Automatic Premium Withdrawal To set up automatic monthly payment of your Part B premium directly from your bank account. This form makes sure you’ll never miss an important payment.Form SF-5510
Income Related Monthly Adjustment (IRMAA) Appeal To appeal your IRMAA surcharge due to a “life-changing event” such as work stoppage / reduction, loss of income-producing property, and many other reasons. Form SSA-44
Application For Termination of Medicare Part A and/or Part B To request to cancel your Medicare Part A and / or Medicare Part B coverage. Form CMS-1763
File A Complaint About The Quality of Healthcare You Received To file a complaint to the Center for Medicare & Medicaid Services about the quality of care you received. This form ensures the Medicare program knows about any issues, so they can be resolved and improved in the future.Form CMS-10287
File A Medicare Claim To file a claim.Form CMS-1490S