Useful Forms, Phone Numbers & Links
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- Sign up for Medicare easy pay
Set up automatic payments for your Part-B premium directly from your bank account
➔ - Medicare proof of creditable coverage
If you sign up for Medicare Part-B after age 65, use this form to show that you had creditable coverage. Without this, you may face penalties due to a coverage gap.
➔ - IRMAA appeal form
If you have a life changing event, such as stopping or reducing work, loss of income, or other reasons, use this form to request a change to your IRMAA surcharge.
➔ - Enroll in Medicare Part-B
Part B helps pay for your basic healthcare services. If you already have Part A, you can add Part B during specific enrollment periods.
➔ - Terminate Part A of your Medicare coverage
You can typically only drop Medicare Part A if you pay a premium for it.
➔ - Terminate Part B of your Medicare coverage
Recent changes to the law require that you now interview with the Social Security Administration before your request goes into effect.
➔ - Filing a complaint
If you’re unhappy with the healthcare you received, you can file a complains with CMS
➔ - Filing a Medicare claim
Typically, claims are filed automatically by your healthcare provider. If something is missed though, you can file the claim here.
➔ - Apply for Medicare under 'exceptional conditions' SEP
Usually, you can only apply for Medicare during certain times without a late enrollment penalty. Use this form to request a special circumstance that excludes that penalty.
➔ - File an Appeal with Original Medicare
If you disagree with a coverage or payment decision by Original Medicare, your Medicare Advantage, or Medicare drug plan you can file an appeal.
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- Benefits & coverage with a Marketplace plan
A quick list of everything that is covered with a Marketplace health insurance plan and what that coverage entails.
➔ - Preventive health services with a Marketplace plan
Almost all health insurance plans include a list of services that are covered free of cost, including all Marketplace plans.
➔ - Cancelling your Marketplace plan
This is typically super easy, but if you are ending coverage for only you (and not your dependents), you’ll need to take a few extra steps.
➔ - Employer coverage tool
If your job offers insurance but it is not considered affordable, you will need to complete this form.
➔ - Calculate your actual Premium Tax Credits to what you received over the past year.
If you received a subsidy for your health insurance, you will need to complete form 8962 BEFORE you file your taxes.
➔ - An example of a form 1095-A and what each box means
You will receive this form each February from the IRS and need it to complete the Form 8962. This is an example of what each field means and how you use it.
➔ - Appealing the Marketplace's eligibility decision
If you don’t agree with a decision made by the Marketplace, you generally have 90 days from the date of your Eligibility Notice to ask for an appeal.
➔ - Exemption application
You need an exemption if you’re 30 or older and want to enroll in a “Catastrophic” health plan. There are 2 types of exemptions: affordability and hardship. Use these forms to apply for an exemption.
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