Medicare Forms


Application for Enrollment in Medicare Part B

The CMS-40B form is for individuals enrolling in Part B. You must apply for Part A first. 

Request for Employment Information

The CMS-L564 form is used when applying for Part B when you have Part A & are covered by an employer plan. This is filled out by your employer.

Medicare Easy Pay

This form is used to sign up for Medicare's Easy Pay electronic, automatic payment option.

Request for Termination of Medicare Part B

The CMS-1763 508 form is for terminating enrollment in Part B. 

SSA-44 Life-Changing Event Form

If you have had a major life-changing event and your income has gone down, use this form to request a change to your monthly adjustment amount.

Part D LEP Reconsideration Request Form

This form is for requesting Part D Late Enrollment Penalty Reconsideration.


Medicare & You - 2024

This handbook covers plans and benefits, beneficiaries' rights, and frequently asked questions.

Medicare Costs - 2024

This document explains your expected medicare costs for 2024 based on your annual household income.
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