Medicare Forms
Important Forms for Medicare
Proof of Creditable Coverage When Applying for Medicare
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
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
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.
