Medicare form CMS 1763 Medicare form CMS 1763

Medicare form CMS 1763

By Ed Crowe | Agent blog | 0 comment | 10 April, 2020 | 0

Medicare form CMS 1763

Once you decide to terminate your Medicare insurance, you need to understand how the process works. First, you will need to fill out a Medicare form CMS 1763.

Download a form CMS 1763 – click here

What do you use Medicare Form CMS 1763 for?

This form is used to terminate the hospital and or medical insurance benefits you receive from Medicare. This is a standard Department of Health and Human Services form it is for use by any Medicare enrollee who wants to stop receiving premium hospital (Medicare Part A) and Supplementary Medical insurance (Medicare Part B).

The only way to stop Medicare Part A and/or Part B enrollment is with the use of this form.

Because this is a very serious decision, other steps are needed to complete this process. In most cases, the claimant will need to do either an in-person or phone interview with a Social Security representative. During the interview the claimant will need to explain the reason for the decision to discontinue benefits. A Social Security representative will explain both the procedure and the results of the termination. The form cannot be submitted before completing the interview. One common reason for this decision is if a person or their spouse has a job that provides lifetime insurance.

When do I file the Medicare CMS 1763 Form?

Because the termination of (Part A) hospital or (Part B) medical insurance is not strictly regulated, enrollees can do it whenever they think it is necessary. The termination will usually take place at the end of the month that they file the request.

Part B after initial election period

You will need to give an employment verification form to the Social Security office to get part B on a delayed basis. CLICK FOR EMPLOYMENT VERIFICATION LETTER

You can apply for Part B online as well. CLICK HERE TO APPLY FOR DELAYED MEDICARE PART B ONLINE

Is it difficult to fill out the CMS 763 Form?

The answer is no. It is a 1 page form. Enrollees simply fill out their name, Medicare ID number, the name of the person making the request (if necessary), determination of the coverage that requires termination, the end date of the insurance, the reason for termination, signature, address, phone number and date.

If the applicant signs with an X, the form requires 2 witnesses to sign as well. The witnesses must know the enrollee personally and include their names and addresses.