Get Help and Submit Medicare Forms CMS-L564 and CMS-40B With No Mistakes

Our team has been helping people in New York transition from employer health insurance to Medicare without stress or penalties for more than 15 years. While we’re located in New York, we are licensed to help in all 50 states.

Two key forms often cause confusion:

1. CMS-L564
2. CMS-40B.

Here’s how we guide you through the process and answer the most common questions that pop up when transitioning from employer health insurance plans to Medicare.

What Is Form CMS-L564 For?

Form CMS-L564, the Request for Employment Information, serves as your proof of group health plan coverage through current employment.

This proof is required if you delayed Medicare Part B enrollment because you had job-based health insurance.

Without this form, you cannot use a Special Enrollment Period (SEP).

What If My Employer Won’t Fill Out CMS-L564?

Unfortunately this happens more often than you think.

If your employer or company official won’t complete Section B, we help you gather alternative proof, such as:

• Pay stubs showing health benefits
• Insurance ID cards
• Employer letters confirming coverage end dates

We then submit these documents with your completed form to the Social Security Administration.

Can I Submit Form CMS-L564 Online?

Yes.

We will guide you through uploading the form and supporting documents to your SSA account at SSA.gov. You can also fax, mail, or deliver them in person to your local Social Security office. We’ll confirm the best option for your situation and help you find the closest office in New York to where you live.

What Is a CMS Form Used For?

CMS forms, issued by the Centers for Medicare & Medicaid Services, are official documents for Medicare enrollment applications. They ensure your eligibility, prevent coverage gaps, and help you avoid late enrollment penalties.

Form CMS-L564 Download

You can download the CMS-l564 form online easy by going here.

What Forms Are Needed for Medicare Part B?

• Form CMS-40B – Application for Enrollment in Medicare Part B
• Form CMS-L564 – Request for Employment Information (required for SEP)

When Can You Apply for Medicare Part B?

You can apply:

• During your Initial Enrollment Period (3 month before and 3 months after the month you turn 65)
• During the General Enrollment Period (Jan 1–Mar 31)
• During a Special Enrollment Period (within 8 months after your coverage ends from current employment)

What Is the CMS-40B Form?

Form CMS-40B is the official application for enrollment in Medicare Part B if you already have Medicare Part A. We help you complete this form correctly and submit it with CMS-L564 when needed.

How We Help You Complete Form CMS-L564

Section A

This is the section you will complete.

We make sure you complete Section A accurately with your name, Social Security Number, and employer details. If you had coverage through a spouse, we include that information.

Section B

This is the section your employer is responsible to complete.

We work with your employer to complete Section B, which confirms employment information, health coverage dates, and includes their signature. If your employer refuses, we help you provide alternative proof.

How We Help You Complete Form CMS-40B

• Fill in your personal details and Medicare number
• Select the correct enrollment period (IEP, SEP, or General Enrollment Period)
• Answer questions about current employment and health coverage
• Sign the form (or use verbal consent by phone)
• Submit the completed form to Social Security with CMS-L564 if required

Special Enrollment Period (SEP)

SEP allows you to enroll in Medicare Part B without penalties if you had employer group health plan coverage. You must apply within 8 months after your coverage ends. We make sure you meet this deadline.

Common Issues We Solve

• Hours Bank Arrangement: If you had coverage through a union or trade group, we ensure this is documented correctly.
• Coverage Gaps: We help you avoid losing medical insurance during the transition off your employer plan and on to Medicare coverage.
• Late Enrollment Penalties: We help you prevent costly mistakes by filing on time.

Common Mistakes When Submitting l564 Forms

We often see people run into issues that delay their Medicare enrollment, and here are the most common mistakes and how we prevent them.

• Employers using incorrect coverage dates on the CMS-L564
• Submitting the wrong version of the form
• Attaching it incorrectly to the online CMS-40B.
• Forgetting the final electronic signature step after typing your name on the 40B form.

These small errors can lead to frustrating delays or penalties. When you work with Plan Medicare, you’re not in it alone. Our team reviews every form, ensures your employer documentation is accurate, and guides you through the online submission process from start to finish, including that crucial signature confirmation step.

We’ve been helping people transition from employer health insurance to Medicare for more than 15 years, and we’d love to help you avoid the hassle and get enrolled smoothly.

l564 Form Submission Checklist

• Meet with an advisor to get help to complete Section A of CMS-L564.
• Get your employer to complete Section B (or attach proof).
• Fill out form CMS-40B.
• Submit both forms to Social Security.
• Avoid coverage gaps and late enrollment penalties by preparing early.

Next Steps and Where to Get Medicare Enrollment Help

There are 3 ways to get help with this, and we think number one is the easiest.

1. Call PlanMedicare and work with our team. We have helped more than 50,000 people navigate Medicare and are looking forward to helping you. Call us today at 516-900-7877.
2. You can call Social Security at 1-800-772-1213 (TTY: 1-800-325-0778)
3. You can visit SSA.gov or Medicare.gov and try to do it online.

Contact our team today and we’ll be ready to help you.