Medicare Related Forms
Enroll in Medicare Easy Pay - Automatic Part B Premium Withdrawl
Use this form to set up automatic monthly payment of your Part B premium directly from your bank account. Never miss an important payment.
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 more.
Other Resources
Medicare & You Handbook
Proof of Creditable Coverage for Applying for Medicare
Use this form to prove you had creditable health insurance when you are signing up for Medicare Part B after age 65 so that you avoid any Part B penalty due to gaps in coverage.