Two essential forms often come into play when enrolling in Medicare Part B: the CMS L-564 (Request for Employment Information) and the CMS 40-B (Application for Enrollment in Medicare Part B). These forms are critical for individuals who missed their initial enrollment period at age 65 and want to avoid penalties or coverage gaps.
Here is a closer look at what these forms are and their specific purposes.
Understanding Medicare Forms CMS-L564 and CMS 40-B
What Is Medicare Form CMS-L564?
The CMS-L564 Medicare form, also known as the “Request for Employment Information,” verifies an individual’s group health plan coverage under an employer. This form is typically required for those who delayed enrolling in Medicare Part B because they or their spouse were covered by employer-sponsored insurance.
Employers must complete Section B of this form to confirm the coverage details, including the start and end dates of the employer group health plan coverage.
What Is Medicare Form CMS 40-B?
The CMS 40-B Medicare form, formally titled “Application for Enrollment in Medicare Part B,” is used to apply for Medicare Part B coverage. This form allows applicants to specify their desired start date for Part B coverage, ensuring continuity of health benefits.
Completing this form is essential for individuals transitioning from an employer-sponsored group health plan to Medicare.
Who Needs to Fill Out Medicare Forms CMS-L564 and CMS 40-B?
The CMS-L564 Medicare form and Medicare form CMS 40-B are necessary for individuals enrolling in Medicare Part B after their initial enrollment period. Typically, this situation arises when a person delays enrolling in Medicare because they or their spouse is still working and covered under an employer-sponsored group health plan. Once they retire or lose employer coverage, they must complete these forms to avoid late enrollment penalties.
For those enrolling in Medicare when they first become eligible at age 65, the process is more straightforward and usually does not involve these forms. Initial enrollment can often be completed online through the Social Security Administration website.
How to Fill Out Medicare Form CMS-L564: Request for Employment Information
The Medicare Part B application form CMS-L564 has two sections:
Section A
This section is to be completed by the applicant. Provide your employer’s name and address, and ensure that all required information is accurate. If you’ve had multiple employers since turning 65, you’ll need to complete a separate CMS-L564 form for each one.
- For the Individual: If you’re applying for yourself, list your name as both the employee and the applicant.
- For a Spouse: If your coverage was through your spouse’s employer, list your spouse’s name as the employee and your name as the applicant.
Section B
Section B must be filled out by your employer or your spouse’s employer. This section verifies the group health plan coverage details, including:
- Whether the applicant was covered under an employer group health plan.
- The start date of the group health plan coverage.
- The end date of the group health plan coverage (if applicable).
Employers often make errors in this section, such as listing the start date of the current insurance carrier rather than the actual start date of the group health plan. Double-check this information to ensure accuracy. Once complete, an authorized representative from the employer must sign and date the form.
How to Fill Out Medicare Form CMS 40-B
The CMS 40-B Medicare form is simpler to complete but equally important. Here are the steps:
- Provide Your Medicare Number: If you’ve already applied for Medicare Part A, you can find this number online at SSA.gov.
- Fill in Your Personal Information: Include your full name, mailing address, and phone number.
- Specify Your Desired Start Date for Medicare Part B: This is the most crucial part of the form. Use the “remarks” section to indicate the exact date you want your coverage to begin. For example, if your employer group health plan ends on August 31st, request a start date of September 1st to avoid any lapse in coverage.
Important Tips for Submitting Medicare Forms CMS-L564 and CMS 40-B
- Submit both forms together to your local Social Security office or upload them online via the SSA website.
- Ensure all information is accurate and complete to prevent processing delays.
- Remember, you have an eight-month Special Enrollment Period (SEP) after losing employer group coverage to enroll in Medicare without penalties.
FAQs
What is the purpose of Form CMS-L564?
This form is used to verify employment and group health plan coverage for enrolling in Medicare Part B without penalties.
What is Form CMS-40B used for?
This form is used for enrolling in Medicare Part B, typically during a Special Enrollment Period.
Who needs to fill out form CMS-L564?
Your employer must complete this form to confirm your health coverage.
Can I submit these forms online?
Yes, you can submit these forms online through your Social Security account or mail them to your local Social Security office.
What information do I need to complete Form CMS-40B?
You’ll need your Social Security Number, Medicare Number, and the type of coverage you are applying for.
What should I do if my employer can’t complete form CMS-L564?
If this is the case, contact Social Security to discuss alternative documentation, such as tax returns or pay stubs, to prove coverage.
How long does it take to process these forms?
Processing these forms typically takes two to four weeks, but delays can occur depending on the volume and completeness of the application.
What happens if I submit incomplete forms?
Incomplete forms can delay your enrollment. Ensure all sections are filled out and signed before submission.
Filling out the Medicare forms CMS-L564 and CMS 40-B can feel overwhelming, but these forms are vital for avoiding late enrollment penalties and ensuring seamless Medicare Part B coverage. If you need assistance, visit MedicareSchool.com to work with one of our free guides.
We understand how difficult making the right Medicare decisions can be. To take the next step, watch our full course here or schedule a free one-on-one call with a certified Medicare School Guide who can answer your questions, compare plan options, and even help you enroll. Click here to get started.