MEDICARE RESOURCES
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SPECIAL FORMS FOR MEDICARE ENROLLMENT & MANAGEMENT
Medicare Form CMS-40B
To apply for Medicare in a Special Enrollment Period, you must have or had group health plan coverage within the last 8 months through your or your spouse’s current employment. People with disabilities must have large group health plan coverage based on your, your spouse’s or a family member’s current employment. This form is used for proof of group health care coverage based on current employment. This information is needed to process your Medicare enrollment application.
Medicare Form CMS-L564
This form is used for proof of group health care coverage based on current employment. This information is needed to process your Medicare enrollment application. The employer that provides the group health plan coverage completes the information about your health care coverage and dates of employment.
LOW-INCOME SUBSIDY
You may use this form if you received a notice that your monthly Medicare Part B (medical insurance) or prescription drug coverage premiums include an income-related monthly adjustment amount (IRMAA) and you experienced a life-changing event (like retirement) that may reduce your IRMAA.
" class="object-cover object-center"> BASED IN PHILADELPHIA, PA
LICENSED & SERVICING: PA, NJ & NY
This is a solicitation for insurance. Submitting your information and/or calling the numbers listed on this website will direct you to a licensed Agent/Broker. Important disclosures: Medicare has neither endorsed nor reviewed this information. Not connected or affiliated with any United States Government or State agency. We do not offer every plan available in your area. Any information we provide is limited to those plans we do offer in your area. If you would like to find more information about the program, please visit the Official U.S. Government website for Medicare, www.medicare.gov; or call 1-800-MEDICARE, thats (1-800-633-4227) TTY users can call: 1-877-486-2048, you can talk/chat live with a real person, 24 hours a day, 7 days a week (except some federal holidays); or you can contact your local State Health Insurance Assistance Program (SHIP) to get information on all of your options.