Get Cms-2384 2018-2025

Filling out the CMS-2384 form can seem daunting, but this guide will walk you through each section step-by-step. This third party premium billing request is essential for individuals who want their Medicare premium bills sent to someone else.

Follow the steps to successfully complete the CMS-2384 form.

1. Click ‘Get Form’ button to access the CMS-2384 form and open it in your chosen editor.
2. Begin by filling in your Medicare number accurately in the designated field to ensure proper identification.
3. Enter your name as the enrollee in the specified section to verify your identity.
4. Provide the name of the third party to whom you wish the Medicare premium bill to be sent. Include a brief explanation for this request in the provided field.
5. Fill in the complete address of the third party, including the street, city, state, and zip code, ensuring all details are correct.
6. Sign the form where indicated to authorize the transfer of billing responsibility.
7. In the 'Request of Third Party Payer' section, have the designated third party fill in their details, including their reason for assuming this responsibility.
8. The third party must also provide their signature and address to formalize the request.
9. Once all fields are completed, review the information for accuracy before finalizing your submission.
10. Save your changes, and you may choose to download, print, or share the form as needed.

Start filling out your CMS-2384 form online today for a smooth and efficient filing experience.