Medicare Forms

The forms people in Grand County need most, linked straight to the official source. Not sure which one you need — or how to fill it out? That’s exactly what we’re here for, free.

Enroll in Medicare (Parts A & B)

Apply for Original Medicare through Social Security — online, by phone, or in person.

Open official form

Apply for Part B (CMS-40B)

The Application for Enrollment in Part B, if you’re not auto-enrolled.

Open official form

Request Employment Information (CMS-L564)

Used with CMS-40B to prove employer coverage when you delayed Part B while working.

Open official form

Apply for Part D Extra Help (Low-Income Subsidy)

Help paying for prescription drug coverage if you have limited income and resources.

Open official form

Appoint a Representative (CMS-1696)

Authorize someone to act on your behalf with Medicare.

Open official form

Medicare Plan Compare

Browse and compare every Medicare plan available in your ZIP code.

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Forms link to official government sources. Moab Medicare is not connected with or endorsed by the U.S. government or the federal Medicare program.

Need help with a form?

Brian will walk you through any Medicare form, free. Call (435) 260-3200.

Book a free review Call (435) 260-3200