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Medicare Forms You Should Bookmark


When you have Medicare, you’ll fill out at least one form. Forms are necessary for enrollment, appeals, and change of authority. Most documents you can find online by downloading the PDF file. Below we’ll discuss the forms you need, how to find them, and where to submit them.

An Explanation of Medicare Forms

Applying for Medicare seems challenging when you’re unfamiliar with the process. The variety of forms can be even more confusing than the Medicare enrollment periods. Well, we have all the details you need to get through Medicare successfully.

Initial Medicare Enrollment Forms

The first step when enrolling in Medicare is to complete an initial enrollment questionnaire. The questionnaire informs Medicare about any other insurance you may have. Different types of coverage could be employer benefits or veterans’ benefits. Initial enrollment questionnaires are online through MyMedicare.gov. But you can answer questions over the phone. You can expect a letter in the mail three months before your Medicare coverage begins. The notice will contain your MyMedicare.gov password, username, and instructions.

Medicare Application Form

Those seeking both Part A and Part B at the same time will file a different form than those that need Part B. Some people may delay Part B to continue working; those people will need to fill out the request for employment information portion. It’s important to remember your Medicare enrollment application goes to Social Security and not Medicare.

Medicare Opt-Out Forms

Medicare isn’t mandatory, but if you delay enrollment, you’ll want to be sure you have creditable coverage. If you have Medicare and Employer coverage, you can talk to the benefits administrator in the office where you work about your options.

Medicare Part A Application Form

You can enroll in Part A online, over the phone, or in-person at the local Social Security office. To apply, you’ll need your birth certificate, proof of citizenship, and a driver’s license.

Part B Forms

If you already have Part A and want to enroll in Part B, you’ll need to complete the CMS-40B form. Now, if you lost Employer coverage, you’ll need to fill out the CMS-L564 Request for Employment Information. You can fill these forms out online, via fax, or send it by mail.

Medicare Part A and Part B Termination Form

If you want to terminate Part A or Part B, you’ll need to fill out the CMS 1763 form. Medicare isn’t Mandatory, but, if you don’t have creditable coverage, you may risk penalties in the future. To Terminate Part B you’ll need to file the CMS-L457 form to acknowledge your request for termination. Further, the form for Part A is the CMS-L458, you’ll fill out this for to acknowledge your request for termination.

Request for Employment Information

To prove you have creditable coverage from an employer or employer group plan, you’ll fill out the CMS-L564 form to prove your eligibility for a Special Enrollment Period.

Part C Scope of Appointment Form

The Medicare Advantage Scope of Appointment form is a paper you fill out before an agent comes to your house to discuss Part C options in your area. There is an electronic Scope of Appointment process that can help maximize proficiency. Although, if you enroll over the phone, the recorded phone call serves as the Scope of Appointment.

Part C Application Form

Once you know which Medicare Advantage plan you want, you’ll complete a Part C enrollment form. Many times, an agent can walk you through the application process over the phone, so you don’t need to worry about filling out the form yourself. Also, you could fill out the application online by yourself.

Medicare Part D Forms

Most Part D prior authorization forms are available online for you to download, print, and take to your doctor to sign. You can usually find the form on the carriers’ site, or you can contact the insurance company to ask them to email you the form. You may need to fill out a Coverage Determination Request Form if your medication requires prior authorization or step therapy.

Easy Pay Form

The Authorization Agreement for Preauthorized Payments form (SF-5510) is the document you’ll complete to authorize Medicare to deduct monthly premiums from your bank account. Once you complete this form, you’ll have Medicare Easy Pay set up.

Medicare Authorization Form to Disclose Personal Health Information

Many times, a spouse will want their partner to have access to their personal health information. If this describes you, fill out the Authorization to Disclose Personal Health Information form. This form is available online, or you can contact Medicare for the information.

Medicare Claim Forms

You may be wondering how to file a Medicare claim. First, it’s unlikely that you’ll have to submit your Medicare claim. Most doctors have a medical billing and coding office that will file claims for you. But, in the rare case you do need to fill out a claim form, you’ll fill out the Patient Request for Medical Payment form (CMS-1490S)

Third-Party Premium Billing Request Form

You can designate a family member or friend to pay Medicare premiums, this is a third-party payer. Then, if Medicare approves the request, premium bills will be sent to the person you designate as the payer. The form is a CMS-2384 third-party premium billing request form. Once you submit this form, Medicare will make a decision.

Medicare Reimbursement Form

There are times where you’ll need to file a claim for Medicare reimbursement. The reimbursement form is the same as the claim form. If you are entitled to a refund when you submit the Patient Request for Medical Payment form, Medicare will reimburse you.

Medicare Grievance Forms

If you wish to file a complaint about a doctor or hospital, you can contact the Quality Improvement Organization. Also, you can contact the State Health Insurance Assistance Program. Submit a Medicare complaint form to file a complaint about your Medicare plan. Contact Medicare if you have an issue with a Durable Medical Equipment supplier or your reporting Medicare fraud. But, if you have private insurance, contacting your plan to discuss complaints is always an option.

Note: Appeals are when you don’t agree with Medicare’s coverage decisions. Complaints are related to treatment and quality of service.

Medicare Appeal Form

Filing an appeal starts with your Medicare Summary Notice. You’ll file an appeal by submitting a Medicare Redetermination Request form to the company on the last page of your Medicare Summary Notice. Those with Medicare Advantage will submit the appeal to the company instead of Medicare.

Consent for Home Visit Form

Form CMS-36 gives consent for federal and state health survey personal to visit your home. During the visit, they would evaluate the quality of home health care.

Medicare Wellness Exam Form

Most likely, your doctor will give you a checklist for your Medicare Wellness Visit to fill out. The form will ask you thinks about your health and lifestyle. Contact your doctor to get your Medicare wellness exam form.

FAQs

Where do I get Medicare Forms?
For the most part, you can find forms on Medicare’s website. But, if you need Medicare, the application goes through Social Security.
What are the CMS forms?
The Centers for Medicare and Medicaid Services has many forms available as PDF and hard copy forms may be available. If your file an appeal or a claim, you’ll likely find the form on the CMS website.
How do I fill out the CMS-L564 form?
The CMS-L564 form has two sections. Section A you’ll fill out and section B, your employer will fill out. When eligible, filling out this form could give you a Special Enrollment Period to enroll in Part B.

How to Get with Your Medicare Supplement Application Form

Our agents will happily help you identify the best coverage options in your area and then walk you through the Medigap application form. We are here to help guide you on your Medicare journey. Give us a call at the number above to get help filling out your Medicare Supplement application form. Or, compare rates online to see your options now.

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Lindsay Malzone

Lindsay Malzone is the Medicare expert for MedicareFAQ. She has been working in the Medicare industry since 2017. She is featured in many publications as well as writes regularly for other expert columns regarding Medicare. You can also find her over on our Medicare Channel on YouTube as well as contributing to our Medicare Community on Facebook.

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