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.