Medicare paperwork can feel overwhelming, but most situations only require a handful of specific forms. Knowing which form to use and where to find it can save you time and prevent delays in your coverage or benefits.
Enrollment Forms
| Form | Purpose | Where to Get It |
|---|---|---|
CMS-40B | Application for Enrollment in Medicare Part B | ssa.gov or your local Social Security office |
CMS-L564 | Request for Employment Information (used with CMS-40B when enrolling outside your IEP due to employer coverage) | ssa.gov |
CMS-18-F-5 | Application for Hospital Insurance (Part A) for those not automatically enrolled | ssa.gov |
CMS-10114 | Notice of Medicare Non-Coverage (NOMNC) - given to you by a provider when services are ending | Provided by your provider |
Appeal Forms
| Form | Purpose | Where to Get It |
|---|---|---|
CMS-20027 | Medicare Redetermination Request (first level of appeal for Original Medicare claims) | cms.gov |
CMS-20033 | Appointment of Representative (authorize someone to act on your behalf in an appeal) | cms.gov |
CMS-10280 | Request for Reconsideration (second level of appeal) | cms.gov |
DAB-101 | Request for ALJ Hearing (third level of appeal) | hhs.gov |
Claims and Coverage Forms
| Form | Purpose | Where to Get It |
|---|---|---|
CMS-1490S | Patient Request for Medical Payment (file a claim yourself if your provider does not) | cms.gov |
CMS-1763 | Request for Termination of Premium Medicare Hospital and/or Supplementary Medical Insurance | ssa.gov |
CMS-10003-OMBPRA | Medicare Advantage Disenrollment Request | Your plan or medicare.gov |
CMS-10260 | Authorization to Disclose Personal Health Information | cms.gov |
Most Forms Are Available at medicare.gov and cms.gov
The official sources for Medicare forms are medicare.gov, cms.gov, and ssa.gov. Be cautious of third-party sites that charge fees for forms that are free from official government sources.
Low-Income Assistance Forms
| Form | Purpose | Where to Get It |
|---|---|---|
SSA-1020 | Application for Extra Help with Medicare Prescription Drug Plan Costs (Low-Income Subsidy) | ssa.gov or 1-800-772-1213 |
SSA-1021 | Application for Medicare Savings Programs (QMB, SLMB, QI) | Your state Medicaid office |
Do I need to fill out a form to enroll in Medicare at 65 if I am already on Social Security?
No. If you are already receiving Social Security benefits when you turn 65, you will be automatically enrolled in Medicare Parts A and B and receive your card in the mail. No form is required.
How do I appeal a Medicare coverage denial?
Start with a Medicare Redetermination Request using form CMS-20027, submitted to the Medicare Administrative Contractor (MAC) that processed your claim. You have 120 days from the date of the initial determination to file.
Can someone else file Medicare forms on my behalf?
Yes. You can authorize a representative using form CMS-10003 or CMS-20033 depending on the situation. A representative can be a family member, attorney, or other trusted person.
Need Help Understanding Your Medicare Options?
Our licensed Medicare experts can help you find the right coverage for your needs.