Medicare
Medicare Forms
Official forms for enrollment, coverage changes, and representation. All links open the official PDF on CMS.gov or SSA.gov.
| Form # | What It's For | Use This When… | Link |
|---|---|---|---|
| CMS-40B | Enroll in Medicare Part B | You already have Part A and need to sign up for Part B | Official Link → |
| CMS-L564 | Prove employer coverage for late enrollment | You delayed Part B because of active employer coverage | Official Link → |
| CMS-1696 | Appoint a Medicare representative | A professional or family member is helping with your Medicare | Official Link → |
| CMS-1763 | Terminate/cancel Medicare Part B | You want to voluntarily disenroll from Part B | Official Link → |
| SF 1199A | Set up Medicare premium auto-pay via direct debit | You want Medicare to deduct premiums from your bank account | Official Link → |
💡 Not sure if you need one of these forms? We can walk you through it.
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Appeals
Appeals Forms
Official forms for appealing Medicare or Social Security decisions at every level.
| Form # | What It's For | Use This When… | Link |
|---|---|---|---|
| CMS-20027 | Request a Medicare redetermination (1st appeal) | You disagree with a Medicare coverage or payment decision | Official Link → |
| CMS-20033 | Medicare reconsideration request (2nd appeal) | Your redetermination was denied and you want a second review | Official Link → |
| SSA-561-U2 | Appeal a Social Security decision | SSA made a decision you disagree with and you want to appeal | Official Link → |
| SSA-3441 | Disability report for SSA appeal | You are appealing a disability decision | Official Link → |
| HA-501 | Request a hearing before an administrative law judge | Your reconsideration was denied and you want a formal hearing | Official Link → |
💡 Appeals have strict deadlines. Don't wait — contact us if you've received a denial.
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Social Security Forms
Official forms for claiming benefits, requesting records, and IRMAA adjustments.
💡 Need help with an IRMAA appeal or Social Security claim? Our team can guide you.
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