The Authorization Agreement for Preauthorized Payments form, or SF-5510, allows Medicare recipients to give the Centers for Medicare & Medicaid Services, or CMS, authority to automatically deduct their monthly Medicare premium from their bank account. The form is available at CMS.gov.
The form requires personal information and financial institution or bank account information. Once the authorization form is processed, which can take six to eight weeks, recipients receive a monthly notice stating CMS automatically deducts a premium from the patient's bank account. Premiums are deducted by CMS around the 20th of every month and appear as an “Automated Clearing House (ACH)” transaction on the bank account statement.