Social Security Form CMS-L564: Verifying Employment Information

The process of applying for Medicare benefits is more complicated than it may initially seem. You can apply for Medicare Part B only during specific parts of the year. If you plan to apply during what’s called a Special Enrollment Period (SEP), then you’ll need to fill out and send in a Form CMS-L564 as part of your application. Consider working with a financial advisor as you create a retirement plan and think about future medical expenses.

What Is Form CMS-L564?

Form CMS-L564 is an employment information form from the Centers for Medicare and Medicaid Services. Applicants use it alongside Form CMS-40B when applying for Medicare Part B during a special enrollment period (SEP). You complete one portion, and your employer completes the other.

You are eligible for the SEP under a specific set of circumstances:

You are currently enrolled in Medicare Part A.
You’ve received group health benefits from an employer – either yours or your spouse’s – at some point in the last eight months.

You qualify for the Special Enrollment Period if you receive employer group health benefits or if those benefits ended within the last eight months. If the employment and/or the coverage has ended, the SEP extends for eight months after the month that the benefits ended.

You use Form CMS-L564 to verify that you meet these conditions. It verifies both the employment and group health plan coverage necessary for eligibility.

When Can You Apply for Medicare Part B?

You should only apply to enroll in Medicare Part B if you’re already enrolled in Medicare Part A. If you haven’t enrolled in Part A, contact the SSA to begin the process. Medicare Part A is free once you turn 65, and most people enroll soon after their birthday. Part B, however, requires you to pay premiums like traditional health insurance.

You have a few options for when to apply for enrollment in Medicare Part B.

The Initial Enrollment Period (IEP): This starts three months before the month you turn 65, and ends three months after the month you turn 65. This is when most people apply for Medicare Part A, and when many also elect to enroll in Part B.
The General Enrollment Period (GEP): If you didn’t enroll during your IEP, you can enroll during this period. It takes place every year between January 1 and March 31. Opting for this path could lead to higher premiums, however.
The Special Enrollment Period (SEP): This only applies if you’re currently receiving group health benefits from an employer; or if those benefits ended within the last eight months.

Usually, you don’t pay a late enrollment penalty if you sign up during the SEP. To prove your eligibility for an SEP, you must fill out and send Form CMS-L564 with your application. This form provides information about your or your spouse’s employment-sponsored group health plan.

How to Fill Out Form CMS-L564

The CMS-L564 form is split into two sections. Section A is completed by the applicant, and Section B must be filled out by the employer. Here’s how to complete each part:

Step 1: Download the Form

Visit the official Medicare website or contact Social Security to obtain the CMS-L564 form.

Step 2: Complete Section A (Applicant)

In Section A, enter your full name, Social Security number, and the name of your current or former employer. Indicate whether the group health coverage was through your own employment or your spouse’s. Then sign and date the form to confirm the information provided.

Step 3: Ask Your Employer to Complete Section B

Your employer fills out Section B. An authorized representative will verify the dates your group health coverage was active and specify whether it was connected to current employment. They must also provide the company’s official name, their own contact details, and then sign and date the form.

Step 4: Submit the Completed Form

Send CMS-L564 along with Form CMS-40B to your local Social Security office. Submission can typically be done by mail, fax or in person. Check with the Social Security Administration for current submission options. Make sure all sections are filled out and signed to avoid processing delays.

Contact Social Security at 1-800-772-1213 if you have questions.

How to Find Your Social Security Office

The SSA website has a tool that allows you to find the Social Security office nearest to you. Once you type in your zip code and click Locate, the nearest office or a list of the nearest offices should appear.

Note that three cities – New York City, Philadelphia and Phoenix – have separate locations dedicated to card services. If you live in one of those cities, then, you’ll have to indicate whether you’re looking for Card Services or Other Services. Since you’re applying for Medicare Part B, be sure to choose Other Services.

Bottom Line

While Form CMS-L564 is designed for a very specific situation, it can still have a big impact. If you need Medicare Part B coverage, enrolling during an alternate period can reduce your costs. If you recently had group health coverage through work, you can apply for Medicare Part B with more flexibility. Form CMS-L564 verifies this coverage to the SSA.

Retirement Tips

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