How To Complete Medicare Form CMS L564

If you're enrolling in Medicare Part B when coming off a group health plan after your Initial Enrollment Period ends, you need Form CMS-L564. We show you how to complete the form in this video.

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[johnkieffer]

What recourse do I have for a former employer's foot dragging in getting him to complete the form? I've waited almost 2 months.

[tommytsui]

Hi, I applied Medicare part B online which has a slightly different format compared to the printed CMS L564 form. It is similar to CMS printed form Section A, which asked for the employer's name and address. I had my health insurance under my wife's employer health plan before she retired. Should I enter my wife's employer's name and address information or mine?

[jacobfischer]

If I retired at the end of a month, and want my Medicare to start the following day, do I have to have the L564 completed before I offically retire? My HR is saying they wont sign it until after I have retired. But wont that cause a delay in my benefits beginning?

[zxisbig]

My question is on the Medicare Part B Enrollment Form 40B, Section 7c: How do we fill out the section that asks for Start Date/Ending Date under "Dates you (or your spouse) worked for employer that provided health coverage" when me and my spouse were both covered under two different employer's healthcare plans (mine & his) and we have two different employment start dates, and two different healthcare insurance start dates with these two employers.

Details: We need to enroll in Part B when my husband retires Aug 1, 2024 and his current employer's health coverage ends. We were both covered by my former employer's health insurance plan from age 65 until I retired in Nov 2021. Starting Dec 2021, we were (and still are) covered under my husband's health coverage plan.

[Ted_Michaels]

Wow - your video did not answer a question I have. Nowhere on the internet, that I can find does any one clarify or define what it means by an employer "signing" the form. What are the stipulations for the employers signature? 1) Can they e-sign it and send it back via an email attachment? Can they print, wet sign, scan and email back ? ...or do they have to wet sign and snail mail the form back to me and I sent that to social security?

[djs]

@4:40 "and there isn't a gap in coverage of more than 8 months, your fine". Hi. Are you sure about that? I thought they were looking back to make sure there was coverage each and every month since you turned 65.

[lolitanoval]

If i will apply Medicare? Do i need to go to the Ss Office? Please response. Thank you. And can I apply medicare by online?