Here you'll find a few of the most commonly needed forms. If you need a form that you can't find just let us know and we'll add it to the list.
Exceptions requests are granted when a plan sponsor determines that a requested drug is medically necessary for an enrollee. Therefore, an enrollee's prescriber must submit a supporting statement to the plan sponsor supporting the request.
Medicare beneficiaries may incur a late enrollment penalty (LEP) if there is a continuous period of 63 days or more at any time after the end of the individual's Part D initial enrollment period during which the individual was eligible to enroll, but was not enrolled in a Medicare Part D plan and was not covered under any creditable prescription drug coverage.
A Medicare Part D plan notifies an enrollee in writing if the plan determines the enrollee has had a continuous period of 63 days or more without creditable prescription drug coverage at any time following his or her initial enrollment period for the Medicare prescription drug benefit. The enrollee will receive an LEP Reconsideration Notice and an LEP Reconsideration Request Form with the written notification. The enrollee or his or her representative may request a review, or reconsideration, of a decision to impose an LEP. An enrollee may only obtain review under the circumstances listed on the LEP Reconsideration Request Form.
WHAT IS THE PURPOSE OF THIS FORM? In order 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. The employer that provides the group health plan coverage completes the information about your health care coverage and dates of employment.From CMS.gov
WHO CAN USE THIS APPLICATION?
People with Medicare who have Part A but not Part BNOTE: If you do not have Part A, do not complete this form. Contact Social Security if you want to apply for Medicare for the first time.
WHEN DO YOU USE THIS APPLICATION?
Use this form:
NOTE: Your IEP lasts for 7 months. It begins 3 months before your 65th birthday (or 25th month of disability) and ends 3 months after you reach 65 (or 3 months after the 25th month of disability).