FORMS & RESOURCES
Medicare-Related Forms
Leaving Employer Group Health (Delayed Part B Enrollment)
CMS-L564E (Employer HR Completes)
CMS40B-E (Employee Completes)
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Other Medicare-Related Forms
Part D Late Enrollment Penalty (LEP) Reconsideration Request Form
SSA-561 Request for Reconsideration
CMS-1490 (Submit claim directly to Medicare)
Generic Scope of Appointment (download)
Generic Scope of Appointment (online)
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Healthcare.gov Forms
Resources
National Council on Aging Benefits Checkup
How Part D Drug Plans Work in 2025
Apply for LIS/Extra Help Online
Apply for Florida Medicaid Online
CVS OTC Online Portal for All Plans
Aetna Links
​Aetna Medical Reimbursement Form
Preferred Care Partners Links
Medical Provider Lookup (Create account online or install app)
Dental Provider Lookup (Choose plan: Preferred Care Partners Medicare Plans)
Vision Provider Lookup (Search by health plan: ICHS Preferred Care Partners)
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AvMed Links
Vision Provider Lookup (Search by health plan: AvMed, Inc. Type: AvMed Medicare)
Attend an AvMed Online Meeting (Talk directly to AvMed local representatives)