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
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.
Request for Employment Information
Form CMS L564 Request for Employment Information verifies employment and employer group health plan coverage.
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
Medicare redetermination request form — 1st Level of appeal
The form CMS-20027 is the Medicare Redetermination Request form for the 1st level of appeal.
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).
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.