The United States federal health insurance program known as Medicare collected approximately 20% of all healthcare payments in 2017. The program has existed since 1976 and is controlled by the US government. It is meant to assist those who are 65 years or older, young people with certain disabilities and individuals having ESRD (End-Stage Renal Disease).
The U.S. Government Offers 4 Different Types of Medicare Programs
- Part A.
Hospice/skilled nursing, facility/home care and inpatient hospital stay. - Part B.
Outpatient care, doctor’s/preventive services and medical supplies. - Part C.
Part A + Part B benefits (provided by private organizations). - Part D.
Prescription drug coverage (provided by private organizations).
What is Form CMS 1763 and Why Do I Need It?
If you’ve decided to terminate your medical insurance (Medicare Part B), you have to file Form CMS 1763. This is the Request for Termination of Premium Hospital and/or Supplementary Medical Insurance. The US government considers this a serious action that may have unforeseen consequences in the future so you may be asked to come for an interview held by representatives of Social Security before filing the request. During the interview, they may assist you with completing the form.
However, if you’re a busy person and do not have time to submit the form manually, you have a great alternative. With PDFfiller, you can submit the document for termination in seconds. Filing a CMS 1763 electronically saves you hours of time, eliminates critical mistakes and ensures high security.
How to Fill Out Form CMS 1763?
Form CMS 1763 is a one-page document. You can easily find it in our library of fillable forms and file it with the help of our powerful editing, signing and sharing features. Here is the basic information that you will be asked to provide:
- Enrollee’s name
- Medicare claim number
- Name of the person who is executing the request for termination
- Date when medical/hospital insurance will expire
- Inactivation if this is the request for cancellation of medical or hospital insurance
Once you’ve provided all these details, you must state the reasons for your decision to terminate your insurance. It is recommended to do so in simple narrative form. The request must be signed by the enrollee. If you just put X (or any other mark) where the signature must be placed, you’ll need to have two other parties as witness for the request by providing their names and addresses. The last step is to indicate your address, contact telephone number and the date you filed the request.
Using PDFfiller for submitting Form CMS 1763 saves you time, eliminates mistakes and makes the process of withdrawing your Medicare plan much easier.
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