Medicare Forms

Downloadable forms for your needs.

Looking for a Medicare form?

The medicare forms below are a few hand-selected of the most commonly used forms. Several forms listed may not be available online, but can be requested by calling either the Social Security Administration or Centers for Medicare & Medicaid Services (CMS). If you need help finding a form, please give us a call.

These forms can also be found on www.medicare.gov

Medicare Enrollment/Disenrollment Forms
CMS-40B
Application for Enrollment in Part B
The form CMS-40B is used to enroll in Medicare Part B for people who already have Medicare Part A. If you do not have Part A, you should contact Social Security instead of completing this form.
CMS-L564
Request for Employment Information
Form CMS L564 Request for Employment Information verifies employment and employer group health plan coverage.
CMS-L457
Acknowledgement of Request for Medicare Part B Termination
The form CMS-L457 is a notice from the Centers for Medicare & Medicaid Services that your Medical Part B medical insurance will end per your request.
Medicare Appeal/Claims Forms
CMS-20027
Medicare redetermination request form — 1st Level of appeal
The form CMS-20027 is the Medicare Redetermination Request form for the 1st level of appeal.
CMS-20033
Medicare Reconsideration Request Form – 2nd Level of Appeal
Form CMS 20033 is a Medicare Reconsideration Request Form 2nd Level of Appeal is for when you are dissatisfied with the decision that was made after completing the Medicare Redetermination Request Form- 1st level of appeal (CMS 20027).
SSA-44
Request for Reconsideration (IRMAA)
Form SSA 44 is a Request for Reconsideration for Income-Related Monthly Adjustment Amount (IRMAA) affecting high income individuals who are paying a higher than normal Part B and Part D premium.