RESOURCES

Documents & Forms

CMS-40B Form

App For Enrollment- Medicare Part B

If you're applying for Medicare under a Special Enrollment Period, you must show that you had health coverage through an employer-sponsored plan within the past 8 months—either your own or your spouse’s. For individuals with disabilities, the coverage must come from a large employer and be tied to current employment, whether yours, a spouse’s, or a family member’s.

This form helps verify that coverage and is necessary to move forward with your Medicare enrollment. We’re here and happy to help you complete and submit it successfully.

CMS-L564 Form

Request for Employment Information

This form serves as proof that you had group health insurance through current employment, which is required to process your Medicare enrollment. The employer who provided the coverage will fill out the section confirming your insurance and employment details. We're happy to assist you with completing and submitting this form.


SSA-44 Form

Request to Reduce Your IRMAA

If you’ve experienced a life-changing event that lowered your household income, you may be eligible to request a reduction in your Income-Related Monthly Adjustment Amount (IRMAA) for Medicare Part B and Part D.

Qualifying life-changing events may include:

  • Marriage or divorce

  • Death of a spouse

  • Retirement or loss of income

  • Loss of income-producing property

  • Employer settlement payment

Use this form if you’ve received a notice stating that your Medicare Part B (medical insurance) or prescription drug coverage premium includes an IRMAA, and your income has recently decreased due to one of these qualifying events.

If you’re unsure whether you qualify, we’re happy to help you review your situation.

Medicare & You Guide

2026

MEDICARE/SS LINKS

Enroll in Medicare

If you're 65 or older, you can enroll online for Parts A and B, or Part A only. You can delay Part B if you're already covered through an employer group health plan.

The application is for retirement benefits and Medicare, or Medicare only.

If you already have Part A and previously declined or never signed up for Part B, you can sign up for Part B only.

Enroll in Part B Only

If you’ve been covered by an active employer group health plan (either yours or your spouse's) since turning 65, and it ended within the last 8 months, you can enroll in Part B without any penalty. This is considered a “Special Enrollment Period.”


Apply-Medicare Part D Extra Help Program

The Extra Help program helps people with limited income and resources lower or cut Part D costs.

Medicare Part D provides drug coverage. The Extra Help program helps with the cost of your prescription drugs, like deductibles and copays. You can apply for Extra Help any time before or after you enroll in Part D.

Apply for Social Security

Apply for Benefits (Retirement, Family, Disability, Survivor) and/or Supplemental Security Income (SSI)

Important Websites

CONTACT US

Mailing Address:

Peterson Insurance Solutions
6650 Rivers Ave. STE 100

Charleston, SC 29406

Serving Aiken, South Carolina and clients nationwide by phone and virtual appointments.

Call:

(803) 346-5848

Site:

https://www.PetersonInsuranceSolutions.com

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