347 N. Pottstown Pike, Suite 200 | Exton, PA 19341

Return Part B

Please follow the instructions that came with your Medicare Card to Return your Medicare Part B.

To Enroll in Part B Later:

  • The Request For Employment Information form provides the creditable coverage information to avoid a Medicare Part B penalty when you enroll later.  This form is not required until you are ready to enroll. 
  • No need to keep this form, we can provide the current version when you are closer to enrollment. 
  • If you change jobs before re-enrolling, you will be required to get this form completed by each employer that provided Group Health Benefits from the time you qualified for Medicare until the time you enroll.