Medicare forms online

Ed Crowe

6 years ago

Medicare forms online

Medicare forms online can help you search for a Medicare form to file a claim, request an appeal, or for Medicare to give someone access to your personal health information?

To get the Medicare form you need, visit Medicare.gov and find the situation that applies to you.

Maybe you’ve been working past the age of 65, have had health coverage through your (or your spouse’s) employer, and are now ready to enroll in Medicare Part B. If so, you’ll most likely need to fill out CMS forms 40B and L564 and take those to your local Social Security office to start Part B coverage. You can find those particular forms on Medicare.gov, too, under “Enrollment Forms.”

To get the Medicare form you need, find the situation that applies to you. Get forms in alternate formats.

I want to make sure Medicare can give my personal health information to someone other than me (Authorization to Disclose Personal Health Information form/CMS-10106).

To file a claim for services and/or supplies that I got (Patient Request for Medical Payment form/CMS-1490S).

I want to start, stop, or change bank accounts for automatic monthly deductions of my Medicare premium (Authorization Agreement for Pre-authorized Payments form/SF-5510).

Medicare forms online – Enrollment forms

I have Part A and want to apply for Part B (Application for Enrollment in Part B/CMS-40B).

I want to sign up for Part B. I’m either currently employed or it is the 8 months after employment or my employer/union coverage ends. I need to provide employment information (Request for Employment Information/CMS-L564).

Medicare forms online – Appeals forms

Appoint a representative to help me file an appeal (Appointment of Representative form/CMS-1696).

Transfer my appeal rights to my provider or supplier (Transfer of Appeal Rights form/CMS-20031

Request an appeal (redetermination) because I disagree with a coverage or payment decision from Medicare (1st level of the appeals process) (Redetermination Request form/CMS-20027).

I am requesting a reconsideration. I’m not satisfied with the decision made during the 1st level of my appeal (Medicare Reconsideration Request form/CMS-20033).

Because I am not satisfied with the decision made at my 2nd appeal, I am requesting a hearing by an Administrative Law Judge (ALJ) . (Request for Hearing by an Administrative Law Judge form/CMS-20034A/B).

If you want to get a list of all Medicare forms, click here.

Crowe and Associates is open from 8:00 am to 5:00 pm M-F. If you have questions, please contact us either buy phone at 203-796-5403 or email teal@croweandassocaites.com.