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Social Security Form CMS-L564

Social Security Form CMS-L564

The process of applying for Medicare benefits is more complicated than it may initially seem. If you want to apply for a portion of Medicare insurance called Medicare Part B, you can only do so during certain 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 also once you start retirement.

What Is Form CMS-L564?

Form CMS-L564 is an employment information form from the Social Security Administration (SSA). It’s used in conjunction with Form CMS-40B when you apply for Medicare part B during a special enrollment period (SEP). One portion is completed by you and the other is completed by your employer or your spouse’s employer.

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

  • You are currently be 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.

In other words, if you currently receive group health benefits from an employer; or if those benefits ended within the last eight months (for instance, because your spouse retired from their job), you will be eligible for the Special Enrollment Period. If the employment and/or the coverage has ended, the SEP extends for eight months after the month that the benefits ended.

Form CMS-L564 is how you 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, you’ll need to contact the SSA to begin the process. Medicare part A is free to enroll in once you turn 65, so most people do so shortly after their 65th 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’ll need to include Form CMS-L564 in your application. This form provides information about your or your spouse’s employment-sponsored group health plan.

How to Fill Out Form CMS-L564

Social Security Form CMS-L564

Form CMS-L564 has two sections, A and B. You will fill out section A and the employer will fill out section B. You’ll need to provide the name and address of your or your spouse’s employer’s. Then, you’ll list your name and your Social Security Number (SSN). If your spouse’s employer was the source of your health benefits, you’ll also need to provide your spouse’s name and SSN. If it was your job providing the benefits, then you’ll need to list your name and SSN again.

The employer providing your group health coverage will complete section B of the form. This section includes information about your group health plan, when you began receiving coverage and if you’re still receiving it, among other things.

How to Submit Form CMS-L564

Once your or your spouse’s employer fills out and signs the form, you can send it along with your completed Form CMS-40B to your local Social Security office. There is no scenario where you should complete Form CMS-L564 and send it in without also sending in a completed copy of Form CMS-40B. You’re welcome to visit your Social Security office in person to submit the documents, or you can mail them.

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 the coverage that Medicare Part B provides, being able to enroll outside the traditional enrollment periods can save you a lot of money. If you receive (or recently received) group health plan coverage through your work or your spouse’s, you can access this greater flexibility to apply for enrollment in Medicare part B when you need it. Form CMS-L564 verifies this coverage to the SSA.

Retirement Tips

  • Whether you’re enrolling in Medicare, electing for Social Security or just starting to think about retirement, your plan could benefit from talking with a financial advisor. Finding a qualified financial advisor doesn’t have to be hard. SmartAsset’s free tool matches you with up to three financial advisors who serve your area, and you can interview your advisor matches at no cost to decide which one is right for you. If you’re ready to find an advisor who can help you achieve your financial goals, get started now.
  • The amount of Social Security benefits you receive will depend in part on what age you choose to elect for them. SmartAsset’s Social Security calculator can help you determine the best age for your situation. If you enter your year of birth and your annual income, the calculator can show you your annual benefit amount for whenever you want to elect. That way you can maximize the benefits you receive.
  • Between 401(k) plans, IRAs, pensions and more, it can be difficult to get a clear view of how ready you are for retirement. By using SmartAsset’s retirement calculator, you can enter all your information and find a customized, monthly savings target. That way, you can formulate the right savings strategy to make your dream retirement a reality.

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