Important Forms for Medicare

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Proof of Creditable Coverage When Applying for Medicare

Form CMS-L564


Use this form to prove you had creditable health insurance when you sign up for Medicare Part B after age 65. This form makes sure you don’t get a Part B penalty for having a gap in coverage.


Income Related Monthly Adjustment (IRMAA) Appeal

Form SSA-44


Use this form to appeal your IRMAA surcharge due to a “life-changing event” such as work stoppage / reduction, loss of income-producing property, and many other reasons. 


Enroll in Medicare Easy Pay - Automatic Premium Withdrawal

Form SF-5510


Use this form to set up automatic monthly payment of your Part B premium directly from your bank account. This form makes sure you’ll never miss an important payment.