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You can also get the sf 5510 as a pdf form in spanish or hmtl form in spanish.
How to sign up for medicare easy pay. How do i sign up for medicare easy pay. Anytime you get a bill for your medicare premium you can sign up for medicare easy pay. Medicare premium collection center po box 979098 st. To complete the form you will need your 11 character medicare number and supply a blank check. Medicare premium collection center.
Louis mo 63197 9000 you ll need your red white and blue medicare id card and a voided blank check from the bank account you want to use in order to complete the form. Fill out the authorization agreement for pre authorized payments form sf 5510 as a pdf in english or html in english. Once you complete the form mail it to the following address. First you fill out the authorization agreement for pre authorized payments form sf 5510. Mail your completed sf 5510 to.
The first step is to complete an automatic payment authorization form sf 5510 and mail it to the following address. Medicare premium collection center po box 979098 st. You can download the pdf in english or spanish. You may have to wait six to eight weeks for your form to be processed and for your mep account to be set up.
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