Cancellation medicare b medical 2026

1. Click ‘Get Form’ to open it in the editor.
2. Begin by checking the box indicating 'I DO NOT want Part B'. This is essential to communicate your decision clearly.
3. If applicable, print the wage earner’s name if it differs from yours. This ensures accurate identification.
4. Enter your Social Security Claim Number in the designated field. This helps link your request to your Medicare account.
5. Provide your written signature in the specified area. Remember, this must be a handwritten signature, not printed.
6. If signing by mark (X), ensure that a witness signs in the appropriate section, along with their address and date signed.
7. Fill out your mailing address completely, including city, state, and ZIP code for proper processing of your request.

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