Medicare Forms

Downloadable forms for your needs.

Looking for a Medicare form?

The medicare forms below are a few hand-selected of the most commonly used forms. Several forms listed may not be available online, but can be requested by calling either the Social Security Administration or Centers for Medicare & Medicaid Services (CMS). If you need help finding a form, please give us a call.

These forms can also be found on www.medicare.gov

Medicare Enrollment/Disenrollment Forms
CMS-40B
Application for Enrollment in Part B
The form CMS-40B is used to enroll in Medicare Part B for people who already have Medicare Part A. If you do not have Part A, you should contact Social Security instead of completing this form.
CMS-L564
Request for Employment Information
Form CMS L564 Request for Employment Information verifies employment and employer group health plan coverage.
CMS-L457
Acknowledgement of Request for Medicare Part B Termination
The form CMS-L457 is a notice from the Centers for Medicare & Medicaid Services that your Medical Part B medical insurance will end per your request.
Medicare Appeal/Claims Forms
CMS-20027
Medicare redetermination request form — 1st Level of appeal
The form CMS-20027 is the Medicare Redetermination Request form for the 1st level of appeal.
CMS-20033
Medicare Reconsideration Request Form – 2nd Level of Appeal
Form CMS 20033 is a Medicare Reconsideration Request Form 2nd Level of Appeal is for when you are dissatisfied with the decision that was made after completing the Medicare Redetermination Request Form- 1st level of appeal (CMS 20027).

More questions?

Speak with a Licensed Insurance Agent.

(214)238-4414, Monday - Friday 8am - 5pm CST

Customer Approved

Trusted By Our Clients

"From our first meeting to the last, our representative was professional, knowledgeable, patient, and quick to respond to our texts, emails, and phone calls!! Nothing but glowing things to say about him and Buffer Benefits!"

Paula Hodges

“My husband and I came to see Buffer Benefits regarding our future plans, specifically Medicare. Our representative took time with us to fully explain everything to our satisfaction and offered very knowledgeable suggestions. We loved his pleasant demeanor and candor, especially his sense of humor. The offices were beautifully decorated so warm and homey and we had a great experience there all around. Thanks so much for your help Buffer! “

Robyn Johnson

“I received excellent and very personal help in making all my insurance decisions. I highly recommend Sean Turner and this group, They are there to serve and help any way they can.“

Joy De Luis

Share This