Medicare Forms and Where to Find Them
You can find most Medicare forms on Medicare.gov. The specific forms you need will depend on what you are trying to do.
Below are some common situations where you may need to submit a form to Medicare.
Enrolling in Medicare
If you are newly eligible and would like to enroll in Medicare, and you’re not automatically enrolled, you will need to submit a Medicare enrollment application to Social Security. You can get this application:
- On the Social Security website.
- By visiting a local Social Security office.
- By calling Social Security at 1-800-772-1213. TTY users can call 1-800-0778. Representatives are available Monday through Friday, from 7AM to 7PM.
Initial Enrollment Questionnaire
If you’re new to Medicare, you’ll need to fill out an Initial Enrollment Questionnaire (IEQ), which lets Medicare know about other health insurance you may have that could be a “primary payer” (meaning it pays before Medicare). Examples of other coverage include employer coverage, veterans’ benefits, and workers’ compensation.
You can fill out the IEQ online at MyMedicare.gov. You should receive a letter in the mail about three months before your Medicare coverage starts with your MyMedicare.gov username, password, and instructions for filling out the IEQ.
Setting up Medicare auto-payments
If you’d like to sign up for Medicare Easy Pay, which automatically deducts your premium payments from a bank account, you will need to fill out an Authorization Agreement for Pre-authorized Payments form. This document can be found on the Medicare website.
Authorizing Medicare to disclose health information
If you’d like to allow Medicare to disclose your personal health information to a person other than you, such as your spouse, you’ll need to fill out an Authorization to Disclose Personal Health Information form. You can find this form on Medicare.gov or contact Medicare for more information.
Filing a claim for services or supplies
Medicare covers certain services and supplies, and in most cases you won’t need to file any claims. If you’re enrolled in a Medicare Advantage plan and wish to file a claim for Medicare-covered services or supplies that weren’t covered, fill out a Patient Request for Medical Payment form and submit it to your health insurance company. You can find this form on Medicare.gov or contact Medicare directly. If you’re enrolled in Original Medicare, Part A and Part B, claims are handled by doctors and suppliers.
Filing an appeal
If you disagree with a Medicare coverage or payment decision, you can file an appeal. The Medicare appeals process is a five-step process. You will need to submit a separate form at each level of appeal.
Filing a complaint
If you’d like to file a complaint, also known as a grievance, against a Medicare provider because of the quality of care or service you received, the process will depend on who or what your complaint is about. Contact the specific points of contact below to ask which forms you need to file a complaint.
- If your complaint is about a provider or hospital, contact your state’s SHIP (State Health Insurance Asssistance Program) or the Quality Improvement Organization (QIO).
- If your complaint is about your doctor, contact your state’s medical board (you can ask your state’s SHIP program for help contacting the board).
- If your complaint is about your Medicare plan, submit a Medicare Complaint Form to provide feedback to Medicare.
- If you have end-stage renal disease (ESRD) and have a complaint about your dialysis services or kidney transplant care, contact your ESRD Network or a State Survey Agency.
- If your complaint is about a durable medical equipment (DME) supplier, contact Medicare directly.
- If you would like to report Medicare fraud, contact Medicare directly.
- If you are enrolled in a Medicare plan, you can also contact the plan directly to discuss any complaint or grievance mentioned above.
Note that a complaint is different from an appeal. A complaint is related to the quality of service or treatment that you received from a provider. If you disagree with your Medicare plan’s decision to not cover or pay for a service or supply, you would file an appeal.
If you can’t find a Medicare form
The above list includes some of the more common situations where you may need to submit a form to Medicare. If you know the name of the form you need, you can search for the document on Medicare.gov or the Centers for Medicare & Medicaid Services website.
For help getting the right form, you can call Medicare directly to speak with a representative. You can reach Medicare at 1-800-MEDICARE (1-800-633-4227). TTY users can call 1-877-486-2048. Representatives are available 24 hours a day, seven days a week.
If you’re in a Medicare plan from a private insurance company, such as Medicare Advantage or a Medicare Part D Prescription Drug Plan, contact your insurance company for more information about which forms you need to submit. You can find this contact information on the back of your Medicare plan insurance card.