Fill out CMS-1763 Medicare Termination Request Online in 2026

What is Form CMS-1763?

Form CMS-1763, Request for Termination of Premium Part A, Part B, or Part B Immunosuppressive Drug Coverage, is how people with Medicare ask to stop coverage they pay a premium for. Social Security handles it for the Centers for Medicare & Medicaid Services.

Who uses Form CMS-1763?

People enrolled in Medicare who want to stop premium Part A, Part B, or Part B immunosuppressive drug coverage, for example because they're covered by an employer plan. If you get premium-free Part A, you usually can't drop it while you receive Social Security benefits.

How to fill out Form CMS-1763?

1. Open the CMS-1763 in the Profi PDF editor.

2. Enter your name and Medicare number exactly as they appear on your Medicare card.

3. Check the coverage you want to end: premium Part A, Part B, or Part B immunosuppressive drug coverage.

4. Add your address and phone number, then sign and date the form.

5. Download and print it.

6. Call Social Security or visit your local office: a representative goes through the form with you and processes it.

Complete your CMS-1763 Medicare Termination Request now!

Prepare your request to end Medicare Part A or Part B

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Where do I file Form CMS-1763?

With your local Social Security office, by mail, fax or in person, after or during the interview. Keep a copy for yourself. Profi PDF helps you fill out the form; it doesn't submit it for you.

Is there a deadline for Form CMS-1763?

No. You can ask to end coverage at any time. Think about it first, though: getting Part B back later can mean waiting for an enrollment period and paying a lifelong penalty.

When is Form CMS-1763 not needed?

If you only want to change your Medicare Advantage or Part D plan, you do that through plan enrollment, not this form. You also don't need it if you never enrolled in the coverage.

Can I sign Form CMS-1763 online?

You can add your signature in the editor before you print. Social Security may ask you to sign during the interview.