official forms
Helpful Links
The Social Security Administration. Apply for benefits, check your earnings record, and manage your account.
Healthcare.gov WebsiteThe federal Health Insurance Marketplace, for individual and family coverage outside of Medicare.
IRMAA Appeal Form (SSA-44) PDFAsk Social Security to reduce your income-related Medicare premium after a life-changing event such as retirement, divorce, or the death of a spouse.
Employer Insurance Verification Form (CMS-L564) WebsiteYour employer completes this form to verify group health coverage when you enroll in Part B after age 65.
enrollment forms
Medicare
Apply through Social Security for help paying Part D prescription drug premiums, deductibles, and copays.
Medicare Savings Programs WebsiteState-run programs that help pay Medicare premiums, and in some cases deductibles and coinsurance.
Medicare Part B Application (CMS-40B) PDFThe form used to enroll in Medicare Part B.
Apply for Medicare Savings Programs / Medicaid Florida onlyFlorida’s MyACCESS portal. Check whether you are eligible and start an application. Residents of other states should apply through their own state agency.
Medicare Costs and Poverty Levels 2026 PDFMedicare’s official publication of the current year’s premiums, deductibles, and coinsurance amounts.
services
Prescription Savings Programs
These are independent discount services, not insurance. They are not part of your Medicare coverage, and amounts paid through them do not count toward your Part D out-of-pocket total. It is worth comparing a discount price against your plan’s copay before you decide.
A mail-order pharmacy service for prescription medications.
Cost Plus Drugs WebsiteSells generic medications at cost plus a fixed markup and pharmacy fee.
GoodRx WebsiteCompares prescription prices across nearby pharmacies and provides discount coupons.
SingleCare WebsiteA free prescription discount card accepted at many major pharmacy chains.
Save on RX WebsiteAnother prescription discount program to compare against your plan pricing.
C-SNP enrollment
Chronic Condition Verification Forms
These forms are used to confirm a qualifying chronic condition when enrolling in a Chronic Condition Special Needs Plan (C-SNP). They are generally completed by your doctor. If you are not sure whether one applies to you, call us before filling anything out.
For CarePlus C-SNP enrollment.
Humana Chronic Verification Form PDFFor Humana C-SNP enrollment.
UnitedHealthcare Chronic Verification Form PDFFor UnitedHealthcare C-SNP enrollment.
Ultimate Chronic Verification Form PDFFor Ultimate C-SNP enrollment.
Gold Kidney C-SNP Verification Form PDFFor Gold Kidney C-SNP enrollment.
These links point to government agencies, carriers, and independent companies that we do not operate or control. We provide them for convenience only, and their content, forms, and eligibility rules can change without notice. If you are unsure which form applies to your situation, call us at (936) 851-4386 before submitting anything.