Medicare Forms

Medicare Form CMS-40B

The purpose of Medicare Form CMS-40B is to apply for Medicare Part B medical insurance. This form is specifically used by individuals who are already enrolled in Medicare Part A (hospital insurance) and wish to enroll in Part B.

By completing Form CMS-40B, you are providing the necessary information to apply for Medicare Part B coverage. This includes personal details such as your name, address, Social Security number, and the effective date for Part B coverage. You may also need to provide information about your current health insurance coverage to ensure coordination with Medicare.

Medicare Form CMS-L564

The purpose of this form is to verify that your current employment-based health insurance coverage is ending or has ended. This form is primarily used by individuals who are eligible for Medicare but are still covered by a group health plan through current employment or the employment of a spouse.

When a person becomes eligible for Medicare and has existing employment-based health coverage, they may need to enroll in Medicare Part B to avoid potential penalties. Form CMS-L564 is used to request information from the employer or the employer’s group health plan administrator to confirm the individual’s current coverage status.

By completing Form CMS-L564, the individual authorizes their employer or group health plan administrator to provide information regarding their employment-based health insurance. This information is then used by the Social Security Administration to determine whether the individual qualifies for a Special Enrollment Period (SEP) to enroll in Medicare Part B without incurring a late enrollment penalty.

You must still complete the Application for Enrollment in Medicare Part B (CMS-40B), to officially enroll in Medicare Part B.

Medicare Form SSA-44

The purpose of Form SSA-44 is to inform the Social Security Administration (SSA) about a significant life-changing event that has caused a reduction in an individual’s income or modified their marital status. These events can include marriage, divorce, death of a spouse, work stoppage, work reduction, loss of income-producing property, or other circumstances that result in a decrease in income.

By completing Form SSA-44 and providing the necessary details about the life-changing event, individuals may be eligible for a reduction in their Medicare Part B and/or Part D premiums. This form allows individuals to request a new initial determination or a reconsideration of their IRMAA based on their changed circumstances.

Get Our Help Today!

At Stroman Insurance Advisors, we provide personalized, unbiased health insurance and Medicare guidance.

Schedule an Appointment