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Special Medicare Forms for Medicare Enrollment and Management:

Application for Enrollment in Part B

For signing up for Part B when you already have Part A (CMS-40B)

 

 

 

 

 

 

Request for Employment Information

Giving the Social Security Administration proof you’re eligible to sign up for Part B if: You’re still working; You retired within the last 8 months; You lost job-based health coverage within the last 8 months (CMS-L564)

 

 

Medicare Income-Related Monthly Adjustment Amount

You may use this form if you received a notice that your monthly Medicare Part B (medical insurance) or prescription drug coverage premiums include an income-related monthly adjustment amount (IRMAA) and you experienced a life-changing event (like retirement) that may reduce your IRMAA (SSA-44)