Medicare Online Forms |
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You can view, print, or electronically submit forms online by accessing the links below. Simply click on the applicable link and you will be directed accordingly. Please call 1-800-MEDICARE (1-800-633-4227) for assistance filling out these forms. TTY users should call 1-877-486-2048.
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Title | Form Number | Purpose | Language Availability |
Medicare Authorization to Disclose Personal Health Information NEW! Online Submission |
CMS-10106 |
Authorizes CMS to disclose personal health information to persons or organizations that you designate. |
English Spanish |
Patient's Request for Medical Payment | CMS-1490S |
Used by the beneficiary to file a claim with Medicare for services and/or supplies received. Click on the link on the left to access the forms and instructions. You will need to print out both the CMS 1490S form and the applicable instructions. The address for form submission is included in the instructions. |
English Spanish |
Medicare Appeals Form |
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Used by the beneficiary to appoint a representative, transfer appeal rights, request a hearing, request a redetermination, or request a reconsideration; depending on the situation. |
English |
Online Medicare Application |
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Used to sign up for Medicare. You can apply for Medicare even if you are not ready to retire. You can use the online Medicare application if you:
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English |
A list of all CMS forms can be found at http://www.cms.hhs.gov/CMSForms/CMSForms/list.asp