Forms
The dozen forms that actually come up
Medicare has hundreds. Nearly every question we are asked involves one of these. Here is what each one does, who receives it, and the trap attached to it.
- What each form does
- Deadlines noted
- We will sit with you while you fill it in
Enrolment
Getting in, and getting out
These four go to the Social Security Administration, which handles Part A and Part B on Medicare's behalf.
| Form | What it is | Notes |
|---|---|---|
| CMS-40B | Application for Enrolment in Part B | For anyone who has Part A and now wants Part B. Filed with Social Security. |
| CMS-L564 | Request for Employment Information | Your employer completes it to prove you had group cover. It is what protects you from the late-enrolment penalty — file it with the CMS-40B. |
| CMS-1763 | Request for Termination of Premium Cover | To withdraw from Part B or premium Part A. Usually requires an interview, deliberately, because the consequences are serious. |
| CMS-1490S | Patient Request for Medical Payment | For claiming reimbursement yourself when a provider will not bill Medicare. |
Income and assistance
Forms that change what you pay
Three forms, each capable of saving a household more than everything else on this page combined.
| Form | What it is | Notes |
|---|---|---|
| SSA-44 | Medicare IRMAA — Life-Changing Event | The appeal against an income-related surcharge. Retirement is the most common successful reason. |
| SSA-1020 | Extra Help with Medicare Prescription Drug Costs | The low-income subsidy application. Free to file, any time of year. |
| State MSP application | Medicare Savings Program | Georgia and South Carolina each run their own. Pays the Part B premium, and sometimes more. |
Plans and appeals
Forms that come from the insurer
These are not Medicare's forms. Each plan has its own version, and the deadlines on them are short.
| Form | When you need it | Notes |
|---|---|---|
| Scope of Appointment | Required before a sales meeting | Records which product types you agreed to discuss, signed before the appointment. Every honest agent uses one. |
| Enrolment request form | Joining a Part C or Part D plan | Paper or electronic. Keep the confirmation number until your card arrives. |
| Appointment of Representative | Letting someone act for you | Needed before a family member can appeal or speak to a plan on your behalf. Fill it in before you need it. |
| Redetermination request | Appealing a plan's denial | The first level of appeal. Deadlines are short, so note the date on the denial letter. |
| Coverage determination / exception | Asking a plan to cover a drug | Used for prior authorisation, a tier exception, or a formulary exception. Your prescriber's supporting statement is what carries it. |
Practical
Four habits that prevent most form problems
Get the employer form early
The CMS-L564 needs a signature from a human being in a human resources department. That takes longer than the deadline suggests, so start before your window opens.
Keep a copy of everything
Date it, copy it, and note who you sent it to. Most disputes we help unwind are settled in ten minutes by someone who kept a photocopy.
Note the deadline on the letter
Appeal windows run from the date on the notice, not the day it arrived. Write the last safe day on the envelope.
Never send your Medicare number by email
Post it, hand it over, or use the official portal. We will never ask you to email it to us.
- Appeal deadlines run from the date printed on the notice, not the date it reached you.
- A prescriber's supporting statement is the single thing most likely to turn a drug denial around.
Forms
Questions about the paperwork
Enrolment and income forms come from Medicare.gov and the Social Security Administration; plan forms come from the insurer. We do not host copies here, because a stale form is worse than no form — go to the official source, or ring us and we will send the current one.
We can sit with you while you complete it, explain every box, and check it before it goes. We cannot sign it for you. Bring it to the office at 418 Bay Laurel Street, Suite 210, or we can do it on a video call.
It is a record of which product types you agreed to discuss, completed before a sales meeting. It exists so nobody can book a Medicare appointment and then spend an hour selling something else. It costs you nothing and commits you to nothing.
A coverage determination request, supported by a statement from your prescriber. If that is denied, a redetermination request is the next level. Both have short deadlines, so start the day the letter arrives rather than the week after.
You need an enrolment request for the new plan, and that is all. Joining a new Part C or Part D plan automatically ends the old one — actively cancelling it as well can create a gap, so let the enrolment do the work.
Bring the form. Bring the envelope too.
Walk in on a weekday morning, or send a photo of the letter. Most form questions take under fifteen minutes once someone is looking at the actual page.
- No cost to you
- Walk-ins weekday mornings
- Photos welcome
Get a free plan review
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