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ENROLLMENT AND CHANGE FORM 4 TERRY DRIVE, SUITE 1 NEWTOWN, PA 18940 Phone: (800) 4828770 Fax: (215) 9686301 BILLING UGPINC.COM Employers Business Name: Form 1B New Employee Business Telephone Number:.

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Although a loss of coverage occurs when employees voluntarily remove themselves from the health plans, the reason (attaining other coverage, including Medicare) is not considered a qualifying event.

You can apply: Online; or. By calling our national toll-free service at 1-800-772-1213 (TTY 1-800-325-0778) or visiting your local Social Security office. Call ahead to make an appointment.

Sign up: Within 8 months after your family member stops working. Part A covers inpatient hospital stays, skilled nursing facility care, hospice care, and some home health care. Covers certain doctors' services, outpatient care, medical supplies, and preventive services. , so you may want to wait to sign up for Part B.

Apply online (at Social Security) – This is the easiest and fastest way to sign up and get any financial help you qualify for. You'll create your secure my Social Security account to sign up for Medicare or apply for Social Security benefits online.

You'll automatically get Medicare Part A (Hospital Insurance) and Part B (Medical Insurance) when you turn 65. You'll still need to make important decisions about your coverage, like whether you need to add drug coverage.

You should start your Part B coverage as soon as you stop working or lose your current employer coverage (even if you sign up for COBRA or retiree health coverage from your employer). You have 8 months to enroll in Medicare once you stop working OR your employer coverage ends (whichever happens first).

To enroll, the first step is to call your local Social Security Administration office or visit Medicare.gov. Click here1 for a listing of Social Security office locations in California.

Medicare Part B (Medical Insurance) Be age 65 or older; Be a U.S. resident; AND. Be either a U.S. citizen, OR. Be an alien who has been lawfully admitted for permanent residence and has been residing in the United States for 5 continuous years prior to the month of filing an application for Medicare.

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© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232
Form Packages
Adoption
Bankruptcy
Contractors
Divorce
Home Sales
Employment
Identity Theft
Incorporation
Landlord Tenant
Living Trust
Name Change
Personal Planning
Small Business
Wills & Estates
Packages A-Z
Form Categories
Affidavits
Bankruptcy
Bill of Sale
Corporate - LLC
Divorce
Employment
Identity Theft
Internet Technology
Landlord Tenant
Living Wills
Name Change
Power of Attorney
Real Estate
Small Estates
Wills
All Forms
Forms A-Z
Form Library
Customer Service
Terms of Service
DMCA Policy
About Us
Blog
Affiliates
Contact Us
Privacy Notice
Delete My Account
Site Map
All Forms
Search all Forms
Industries
Forms in Spanish
Localized Forms
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
airSlate workflows
DocHub
Instapage
Social Media
Call us now toll free:
1-877-389-0141
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232