Navigating Medicare paperwork shouldn’t require a law degree. We’ve compiled the most commonly needed CMS forms below, with plain-language explanations of when and why you’d use each one. If you’re not sure which form applies to your situation, call us or schedule a free appointment. That’s exactly what we’re here for.
(703) 969-1811 | Schedule an Appointment
Enrollment Forms
Form CMS-40B — Application to Start Medicare Part B If you’re over 65, were covered under a group health plan through an employer, and are now ready to enroll in Medicare Part B, this is your starting point. This form is submitted to Social Security and triggers your enrollment in Part B coverage. When to use it: You’re retiring or losing employer coverage and need to activate Part B.
Form CMS-L564 — Request for Employment Information Your employer completes this form to confirm you had qualifying group health coverage. Social Security requires it alongside your CMS-40B to verify that you’re eligible for a Special Enrollment Period rather than the standard enrollment window. When to use it: Your employer needs to certify your prior group coverage so you can enroll in Part B without a late penalty.
Form SSA-795 — Statement of Claimant If your employer is unable or unwilling to complete the CMS-L564, this form allows you to personally attest to your prior qualifying coverage. It’s an important backup that many people don’t know exists. When to use it: Your former employer is out of business, unresponsive, or cannot provide the L564.
Appeals & Penalty Forms
Form SSA-44 — Medicare Income-Related Monthly Adjustment Amount (IRMAA) If Medicare is increasing your Part B or Part D premiums because of your income, but your income has recently decreased — due to retirement, divorce, death of a spouse, or other life event — you can appeal using this form. When to use it: Your income dropped significantly from what Medicare is using to calculate your premium.
2026 Medicare Costs & Part B Premium Reference Sheet Not a form, but an essential reference. Use this to understand your current Part B premium based on income bracket before filing an IRMAA appeal.
Part D Late Enrollment Penalty Reconsideration If Medicare assessed a Late Enrollment Penalty on your Part D drug coverage but you had qualifying drug coverage elsewhere during that period, you can request reconsideration using this form. When to use it: You had creditable drug coverage (through an employer, VA, or other source) but Medicare doesn’t have a record of it.
Medical Payment Forms
Form CMS-1490S — Patient’s Request for Medical Payment Use this form when Medicare should have paid a provider directly but didn’t — and you paid out of pocket. You’re requesting that Medicare reimburse you for covered services. When to use it: You received Medicare-covered services but were billed directly and need reimbursement.
Not Sure Which Form You Need?
Medicare paperwork is confusing by design. If you’re not certain which form applies to your situation, or you need help filling one out, The Stern Team is here to help at no cost to you.
(703) 969-1811 (call or text) jeremy.stern@healthmarkets.com