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Medicare Forms You Should Bookmark

Summary: Medicare forms are necessary when you wish to make changes to your benefits, appeal a decision, or enroll in coverage. Find all of the forms you need below.  Estimated Read Time: 3 min

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Table of Contents:

  1. Medicare Enrollment Forms
  2. Medicare Appeal Forms
  3. Other Medicare Forms
  4. Understanding Medicare Forms

There are certain forms you must complete when you wish to enroll in Medicare, appeal a Medicare decision, or apply for financial assistance. Additionally, there are a variety of other forms available for different situations you may find yourself in. Anytime you wish to make a change to any part of your Medicare coverage, you will likely be required to fill out a Medicare form provided by CMS.

These forms help keep things organized and streamline the process of making these changes without having to spend hours on the phone with a Medicare representative. However, finding the right form for your situation may be overwhelming and difficult to navigate.

There are three main categories of Medicare forms.

  1. Enrollment forms
  2. Appeal Forms
  3. Other Forms

Medicare Enrollment Forms

If you are not automatically enrolled in Original Medicare, you will be responsible for enrolling in coverage on your own. This means, you must fill out the proper form, send it to your local Social Security office, and wait for processing.

There are several forms to choose from when initially enrolling in benefits, and the form you complete will depend on the coverage you are enrolling in (Medicare Part A or Medicare Part B) and when you are enrolling.

The most common enrollment forms include:

CMS-40B – This form allows you to enroll in Medicare Part B when you are already enrolled in Medicare Part A.

CMS-L564 – This is the form you will need to complete to provide the Social Security Administration proof of employment. You will use this form if you are enrolling in Part B and are:

  • Still working
  • Retired within the last 8 months
  • Lost job-based health coverage within the last 8 months

CMS-10797 – This form allows you to enroll in Medicare Part A and Part B using a Special Enrollment Period.

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CMS-10798 – This form allows you to enroll in the Medicare Part B Immunosuppressive Drug benefit.

Medicare Appeal Forms

Medicare appeal forms are available for various types of appeals. Whether you believe your premiums should be lowered due to your income or do not agree with a coverage decision, CMS has a form available for you to plead your case.

Additionally, if you submit an appeal and do not agree with the outcome, there are additional forms available to appeal the decision of your original appeal. This way, your case can be viewed by various individuals who will determine the outcome.

The most common appeal forms include:

CMS-20027 – This is the form you will complete when requesting a redetermination if you disagree with Medicare’s decision on a coverage or payment issue.

CMS-20033 – This is the form you will complete if you are unhappy with the outcome of your CMS-20027 appeal decision. Also known as a 2nd appeal.

OMHA-100 – This form allows you to request a hearing by an Administrative Law Judge if you are not satisfied with the outcome of your 2nd appeal.

CMS-1696 – This is the form you will complete if you wish to appoint a representative to file an appeal on your behalf.

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CMS-20031 – This form allows you to transfer your appeal rights to your provider or supplier to file an appeal if Medicare does not pay for services.

Other Medicare Forms

In addition to enrollment and appeal forms, CMS also provides forms for situations that may not be as common for your everyday healthcare. If you find yourself receiving services from an individual or company that does not bill to Medicare or if you wish to make a change to your Medicare premium payment method (easy pay), you can find a form to help your situation.

Common Medicare forms include:

CMS-1490S – This form allows you file a claim for a service if your provider does not file the claim.

CMS-10106 – This is the form you will complete if you wish to allow Medicare to speak with someone you choose on your behalf about your claims.

SF-5510 – This form allows you to start or stop automatic payments of your Medicare premiums through Easy Pay. This form also allows you to change the banking information set up for your automatic payments.

Understanding Medicare Forms

Each of the Medicare forms listed above are available in both English and Spanish. However, if you require the form in another language, an interpreter can be set up through CMS. If you need help with any aspect of your coverage, our agents will happily help you identify 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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Sources

MedicareFAQ is dedicated to providing you with authentic and trustworthy Medicare information. We have strict sourcing guidelines and work diligently to serve our readers with accurate and up-to-date content.

  1. CMS Forms List, CMS. Accessed November 2023.
    https://www.cms.gov/medicare/forms-notices/cms-forms-list
Jagger Esch

Jagger Esch

Medicare Educator
Jagger Esch is the Medicare Educator for MedicareFAQ and the founder, president, and CEO of Elite Insurance Partners and MedicareFAQ.com. Since the inception of his first company in 2012, he has been dedicated to helping those eligible for Medicare by providing them with resources to educate themselves on all their Medicare options. He is featured in many publications as well as writes regularly for other expert columns regarding Medicare.
Ashlee Zareczny

Ashlee Zareczny

Compliance Manager
Ashlee Zareczny is the Compliance Manager for MedicareFAQ. As a licensed Medicare agent in all 50 states, she is dedicated to educating those eligible for Medicare by providing the necessary resources and tools. Additionally, Ashlee trains new and tenured Medicare agents on CMS compliance guidelines. Ashlee is a Medicare expert who specializes in Medicare Supplement, Medicare Advantage, and Medicare Part D education.

4 thoughts on "Medicare Forms You Should Bookmark"

  1. What address do I send my Medicare Part B payment to? I am not receiving Social security benefits for 2 more years, so it can not be deducted from my benefits yet.

    1. Hi Machelle, to mail in you Part B Payment please use the return envelope that came with your bill, and mail your Medicare payment coupon and payment to:
      Medicare Premium Collection Center
      PO Box 790355
      St. Louis, MO 63179-0355

  2. I recently filed for medicare because I thought it was manditory. I am still employed and have medical coverage thru my employer with and HSA account. I am not receiving any social security yet since I am still employeed. How do I opt out of Plan A, Hospital?

    1. Jill, to delay Medicare Part A, you can contact your local Social Security office over the phone or in person.

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