" class="object-cover object-center"> MEDICARE RESOURCES
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EXTRA HELP RESOURCE LINKS:
SPECIAL FORMS FOR MEDICARE ENROLLMENT & MANAGEMENT
Medicare Form CMS-40B
To apply for Medicare in a Special Enrollment Period, you must have or had group health plan coverage within the last 8 months through your or your spouse’s current employment. People with disabilities must have large group health plan coverage based on your, your spouse’s or a family member’s current employment. This form is used for proof of group health care coverage based on current employment. This information is needed to process your Medicare enrollment application.
Medicare Form CMS-L564
This form is used for proof of group health care coverage based on current employment. This information is needed to process your Medicare enrollment application. The employer that provides the group health plan coverage completes the information about your health care coverage and dates of employment.
LOW-INCOME SUBSIDY
You may use this form if you received a notice that your monthly Medicare Part B (medical insurance) or prescription drug coverage premiums include an income-related monthly adjustment amount (IRMAA) and you experienced a life-changing event (like retirement) that may reduce your IRMAA.
BASED IN PHILADELPHIA, PA
LICENSED & SERVICING: PA, NJ & NY
This is a solicitation of insurance. Agent is a licensed and certified representative of multiple Medicare Advantage and Prescription Drug plans each with a Medicare contract. Enrollment depends on contract renewal. Contact may be made by an insurance agent or insurance company. Not affiliated with or endorsed by any government entity or agency. "We do not offer every plan available in your area. Currently we represent several organizations which offer many products in your area. Please contact Medicare.gov, 1-800-MEDICARE MEDICARE (TTY: 1-877-486-2048), 24 hours a day, 7 days a week, or your local State Health Insurance Program (SHIP) to get information on all your options." This is a proprietary website and is not associated, endorsed or authorized by the Social Security Administration, the Department of Health and Human Services or the Center for Medicare and Medicaid Services. This site contains decision-support content and information about Medicare, services related to Medicare and services for people with Medicare. If you would like to find more information about the Medicare program please visit the Official U.S. Government Site for People with Medicare located at http://www.medicare.gov