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AFT MEDICARE ENROLLMENT APPLICATION Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DM EPOS) SuppliersRCMS855SDSee page 1 for a list of the DM EPOS Supplier Standards. To enroll in the
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Read the instructions carefully before starting to fill out the form.
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Gather all the necessary documents and information required for the application.
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Provide personal information such as name, address, date of birth, and social security number.
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Indicate whether you are applying for the original Medicare program or making changes to an existing plan.
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Fill out the sections related to your eligibility and enrollment information accurately.
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Specify your preferred healthcare coverage options and additional benefits if applicable.
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Who needs form medicare program and?

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Individuals who are 65 years or older and eligible for Social Security benefits.
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People under 65 with certain disabilities or medical conditions may also need the Medicare program.
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Those who want health insurance coverage for hospital stays, medical services, and prescription drugs.
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Anyone desiring additional coverage options not typically provided by other health insurance plans.
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Form Medicare program is a form that individuals must complete in order to enroll in the Medicare program.
Individuals who meet certain eligibility criteria, such as age or disability status, are required to file form Medicare program.
Form Medicare program can be filled out online, by mail, or in person at a local Social Security office.
The purpose of form Medicare program is to gather information from individuals who wish to enroll in the Medicare program.
Form Medicare program requires individuals to provide personal information, such as their name, address, and date of birth.
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