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.