Forms
1) Medicare Easy Pay
If you are not drawing social security benefits, Medicare will send you a bill on a quarterly basis every 3 months for your Medicare Part B premium by default.
If you would rather have an automatic withdrawal of your Medicare premiums set up from your checking or savings account on a monthly basis, you can easily set this up through Medicare Easy Pay. We highly recommend this service because it’s much easier AND you are less likely to miss a payment which could risk your benefits. Deductions are on the 20th of the month (or the next business day). You can sign up 2 ways: online or by filling out a paper form and mailing it to CMS.
Click Here to Log into (or create) your secure Medicare account — Select "My Premiums" and then "Sign Up" to complete a short, online form.
Or Fill out, print and mail the Medicare Easy Pay Form.
2) Proof of Credible Coverage When Applying for Medicare
Use this form to prove you had credible coverage when you sign up for Medicare Part B after the age of 65. This form is used for proof of group health care coverage based on current employment to avoid any possible late Part B penalties.
3) Income Related Monthly Adjustment (IRMAA) Appeal Form - Use this form to appeal your IRMAA surcharge due to a life changing event.
4) Application For Enrollment in Medicare Part B Use this form to apply for Medicare Part B which is coverage for Medicare Insurance. This form gets the process started.