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Health Insurance Advisors, LLC

Medicare Forms

Scope of Appointment

Fill this out and bring with to your appointment or send prior to appointment.

Medicare Explained

Our own Medicare explanation form. Parts A, B, C & D and all of the Medicare plan options.

Medicare Part B App.

Application to enroll in Part B, if you already have Part A. Example: Worked past age 65.

Employer Part B App.

Application to enroll in Part B if you already have Part A for your employer to fill out.

Waive Part A/B

Form to fill out and send in if you want to waive Medicare Part A & B.

Auto Pay Part B

If you are not on Social Security, you get a bill for Part B. Sign up for auto pay here.

IRMAA Part B

Find out how much more you will pay for Medicare Part B if you have a high income.

IRMAA Part D

Find out how much more you will pay for Medicare Part D if you have a higher income.

Update your Information

Need to update your info. or send a drug list?

Blue Cross Reimbursement

Use this to send in a reimbursement request to Blue Cross.

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