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Helpful forms and documentation

Medicare

Request for Employment Information Form (CMS L564)

This is used to verify employment for those signing up for Medicare after 65 due to being covered by an employer plan.
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Medicare Part B Enrollment Form (CMS 40B)

This form is used by those who already have Medicare Part A, but not Part B, and they would now like to sign up for Medicare Part B.
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Income Appeal Form (SSA 44)

This form is used to appeal the income figure Medicare is using for you to determine your Part B premium.
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90DaysFromRetirement.com is an educational resource provided by Senior Benefits Insurance Services. Medicare has neither reviewed nor endorsed this information. Not connected with or endorsed by the United States government or the federal Medicare program. Calling our phone number will connect you to a licensed broker who is trained and certified to help you review the plan options available in your area. Currently we represent between zero (0) and nine (9) organizations which offer between zero (0) and fifty-two (52) products in your area. You can always contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program for help with plan choices.