To get the Medicare form you need, find the situation that applies to you.
- I want to make sure Medicare can give my personal health information to someone other than me (Authorization to Disclose Personal Health Information form/CMS-10106)
- I want to file a claim for services and/or supplies that I got (Patient Request for Medical Payment form/CMS-1490S)
- I want to start, stop, or change bank accounts for automatic monthly deductions of my Medicare Premium (Authorization Agreement for Pre-authorized Payments form/SF-5510)
- I have Part A and want to apply for Part B (Application for Enrollment in Part B/CMS-40B)
- I want to sign up for Part B while I’m employed or during the 8 months after my employment or my employer/union coverage has ended, and I need to provide employment information (Request for Employment Information/CMS-L564)
- I want to appoint a representative to help me file an appeal (Appointment of Representative form/CMS-1696)
- I want to transfer my appeal rights to my provider or supplier (Transfer of Appeal Rights form /CMS-20031)
- I want to request an appeal (redetermination) because I disagree with a coverage or payment decision from Medicare (1st level of the appeals process) (Redetermination Request form/CMS-20027)
- I want to request a reconsideration because I’m not satisfied with the decision made during the 1st level of my appeal (Medicare Reconsideration Request form/CMS-20033)
- I want to request a hearing by an Administrative Law Judge (ALJ) because I’m not satisfied with the decision made during the 2nd level of my appeal (Request for Hearing by an Administrative Law Judge form/CMS-20034A/B)
For other forms, you can visit CMS.gov and use the “search” feature to more quickly locate information for a specific form number or title.