Direct links to the actual CMS and Social Security forms people ask about most — with a plain-language explanation of what each one does, so you know you're looking at the right one before you download it.
Every link below goes straight to the official form on cms.gov or ssa.gov — not a third-party copy. These are the actual documents, not a summary. If you're not sure which one applies to your situation, that's exactly what a PharmSurance advisor is for — reach out before you fill anything out, and we'll help make sure it's the right form.
Use this if you didn't get enrolled in Part B automatically — during your Initial Enrollment Period, a Special Enrollment Period after losing employer coverage, or the General Enrollment Period (January 1 – March 31).
View & download the form ↗Submitted together with CMS-40B when you're enrolling in Part B after losing coverage through a current or recent employer. You complete Section A; your employer completes Section B to confirm your coverage dates — this is what protects you from a late enrollment penalty.
View & download the form ↗If your situation doesn't fit the standard enrollment windows — certain exceptional circumstances CMS recognizes on a case-by-case basis — Medicare.gov's enrollment forms hub has the current versions of these forms and walks through which one applies.
View the enrollment forms hub ↗One common point of confusion: if you're not yet collecting Social Security and still have qualifying employer coverage, delaying Medicare requires no form at all — you simply don't enroll during your Initial Enrollment Period. The CMS-1763 form below only comes into play if you're already automatically enrolled and need to opt out.
If you're paying a higher Part B or Part D premium because of your income (IRMAA), and your income has since dropped because of retirement, divorce, the death of a spouse, or another qualifying event, this form asks Social Security to recalculate your premium using your current income instead of your tax return from two years ago.
View & download the form ↗This is the form for declining Part B if you're still working. It applies in two situations: if you're already collecting Social Security, Medicare enrolls you in Part A and B automatically at 65 whether you want it or not — this form is how you decline Part B while you still have qualifying employer coverage. It's also used to voluntarily cancel Part B later, if you go back to work and gain employer coverage after already being enrolled. Either way, it's the one form here you can't just mail in on your own — it requires a personal interview with Social Security first.
View the form ↗By law, 1-800-MEDICARE can't discuss your Medicare information with anyone but you — including a spouse or adult child — unless you've given written permission. This form is how you add someone to the list of people Medicare is allowed to talk to about your account.
View & download the form ↗If you disagree with a decision Medicare made on a claim — a service or item you believe should have been covered — this is the form for the first level of appeal. You'll need the date of the original decision and your reasons for disputing it.
View & download the form ↗Some of these forms have real, permanent consequences — especially CMS-1763, which ends your Medicare coverage. Others, like SSA-44, can save real money but require the right supporting documentation to be approved. A quick conversation with your advisor before you submit is almost always worth the few minutes it takes.
Tell your PharmSurance advisor what you're trying to do, and they'll point you to the right form — or handle it with you directly. At no cost to you.
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