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  • Equitable relief - Medicare Rights Center
    I am writing to request that the Social Security Administration grant me equitable relief by waiving my Medicare Part B premium penalty and allowing me to enroll in part B effective [immediately retroactive] to [specific date]
  • Notices and Forms | CMS - Centers for Medicare Medicaid Services
    As under original Medicare, a hospital must issue to plan enrollees, within two days of admission, a notice describing their rights in an inpatient hospital setting, including the right to an expedited Quality Improvement Organization (QIO) review at their discharge
  • Forms, Publications, Mailings - Medicare
    Read, print, or order free Medicare publications in a variety of formats Find out what to do with Medicare information you get in the mail Find official forms, publications, and mailings from Medicare
  • Request to lower an Income-Related Monthly Adjustment Amount (IRMAA)
    Fill out the Medicare Income-Related Monthly Adjustment Amount – Life-Changing Event (SSA-44) (PDF) form Fax or mail your completed form and evidence to a Social Security office Available in most U S time zones Monday through Friday, 8 a m to 7 p m , in English, Spanish, and other languages
  • Can I get a Medicare Part B late-enrollment penalty removed?
    Here’s a sample letter to guide you Once you’ve put everything together, you can submit your equitable relief request to your local Social Security office (Contact Social Security at 1-800-772-1213 or check www ssa gov to find the mailing address for your local office )
  • Assistance for Individuals with Medicare Part A and Marketplace . . .
    This tip sheet explains the equitable relief, eligibility criteria and steps for Medicare beneficiaries if they want to enroll in Medicare Part B or request a Medicare Part B late enrollment penalty reduction
  • Equitable relief - Medicare Interactive
    To request equitable relief, you or your representative should write a letter to your local Social Security office explaining that you received misinformation that caused you to delay enrollment
  • Free Medical Hardship Letter – Sample - PDF | Word – eForms
    A medical hardship letter is used by a person to request partial or full forgiveness of medical debt from a hospital or healthcare provider The person seeking leniency should be able to demonstrate serious financial hardship that convinces the hospital that they are unable to pay their debts




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