App For Enrollment- Medicare Part B

If you're applying for Medicare under a Special Enrollment Period, you must show that you had health coverage through an employer-sponsored plan within the past 8 months—either your own or your spouse’s. For individuals with disabilities, the coverage must come from a large employer and be tied to current employment, whether yours, a spouse’s, or a family member’s.
This form helps verify that coverage and is necessary to move forward with your Medicare enrollment. We’re here and happy to help you complete and submit it successfully.

CMS 40B Form-Digital Link

Request for Employment Information

This form serves as proof that you had group health insurance through current employment, which is required to process your Medicare enrollment. The employer who provided the coverage will fill out the section confirming your insurance and employment details. We're happy to assist you with completing and submitting this form.

CMS L564 Form-Digital Link

Use this form if you’ve received a notice that your monthly Medicare Part B (medical insurance) or prescription drug coverage premium includes an Income-Related Monthly Adjustment Amount (IRMAA), and you’ve experienced a life-changing event—such as retirement—that may lower your IRMAA.

The official U.S. government Medicare handbook for 2025

If you're 65 or older, you can enroll online for Parts A and B, or Part A only. You can delay Part B if you're already covered through an employer group health plan.

The application is for retirement benefits and Medicare, or Medicare only.

If you already have Part A and previously declined or never signed up for Part B, you can sign up for Part B only.

App For Enrollment- Medicare Part B

If you’ve been covered by an active employer group health plan (either yours or your spouse's) since turning 65, and it ended within the last 8 months, you can enroll in Part B without any penalty. This is considered a “Special Enrollment Period.”

The Extra Help program helps people with limited income and resources lower or cut Part D costs.

Medicare Part D provides drug coverage. The Extra Help program helps with the cost of your prescription drugs, like deductibles and copays. You can apply for Extra Help any time before or after you enroll in Part D.

Request to lower an Income-Related Monthly Adjustment Amount (IRMAA)

If you've had a life-changing event that reduced your household income, you can ask to lower the additional amount you'll pay for Medicare Part B and Part D.

Life-changing events include marriage, divorce, the death of a spouse, loss of income, and an employer settlement payment.

(See SSA-44 Form below)

Apply for Benefits (Retirement, Family, Disability, Survivor) and/or Supplemental Security Income (SSI)