Medicare Forms

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

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.

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

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

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.

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

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

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