Form CMS-10797 Application for Medicare Part a and Part B - Special Enrollment Period (Exceptional Conditions)

What Is Form CMS-10797?

This is a legal form that was released by the U.S. Department of Health and Human Services - Centers for Medicare and Medicaid Services on April 1, 2022 and used country-wide. As of today, no separate filing guidelines for the form are provided by the issuing department.

FAQ

Q: What is the Form CMS-10797?
A: The Form CMS-10797 is an application for Medicare Part A and Part B - Special Enrollment Period (Exceptional Conditions).

Q: Who can use the Form CMS-10797?
A: The Form CMS-10797 can be used by individuals who are applying for Medicare Part A and Part B and qualify for a Special Enrollment Period due to exceptional conditions.

Q: What is a Special Enrollment Period?
A: A Special Enrollment Period is a time outside of the initial enrollment period when individuals can sign up for Medicare Part A and/or Part B. It is available to those who have certain life events, such as losing other health coverage or moving.

Q: What are exceptional conditions?
A: Exceptional conditions are circumstances that may prevent an individual from enrolling in Medicare during the regular enrollment periods. These conditions may include natural disasters, public health emergencies, or other unique circumstances.

Q: How do I fill out the Form CMS-10797?
A: To fill out the Form CMS-10797, you will need to provide your personal information, such as your name, address, and Social Security number. You will also need to explain the exceptional conditions that qualify you for a Special Enrollment Period.

Q: Is there a deadline for submitting the Form CMS-10797?
A: Yes, there is a deadline for submitting the Form CMS-10797. You must submit the form within 60 days from the date the exceptional condition begins or ends, or within 60 days from the date you were notified of the availability of the Special Enrollment Period.

Q: What happens after I submit the Form CMS-10797?
A: After you submit the Form CMS-10797, your application will be reviewed by Medicare. If you are approved, you will receive a notice with information about your Medicare coverage and effective dates.

Q: Can I appeal if my Form CMS-10797 application is denied?
A: Yes, if your Form CMS-10797 application is denied, you have the right to appeal the decision. The notice you receive will include instructions on how to appeal.

Q: Who should I contact if I have questions about the Form CMS-10797 or the application process?
A: If you have questions about the Form CMS-10797 or the application process, you can contact the Medicare helpline at 1-800-MEDICARE (1-800-633-4227) or your local Social Security office.