Medicare forms for people leaving employer coverage
CMS-L564 and CMS-40B: Medicare Forms for Working Past 65
If you delayed Medicare Part B because you had employer group health coverage, two forms often come up when it is time to enroll: CMS-L564 and CMS-40B. MedigapRx helps clients understand what these forms do, when they may be needed, and how to avoid timing mistakes when leaving employer coverage.
If you are over 65, still working, covered through a spouse, retiring, or leaving employer health insurance, Medicare paperwork can feel more stressful than the actual coverage decision. The forms are not long, but the timing and documentation matter.
CMS-L564 and CMS-40B are commonly used when someone delayed Medicare Part B because they had job-based group health coverage and now wants to enroll in Part B through a Special Enrollment Period.
The Medicare Part B enrollment application for people who already have Part A and want Part B.
The employer information form used to show group health plan coverage based on current employment.
The Part B Special Enrollment Period can be tied to when work or job-based coverage ends.
COBRA, retiree coverage, Marketplace coverage, and active employer coverage are not the same.
What Is CMS-40B?
CMS-40B is the application used to request enrollment in Medicare Part B if you already have Medicare Part A and want Part B. CMS says the form can be used during an Initial Enrollment Period, General Enrollment Period, or when someone qualifies for a Special Enrollment Period.
If you do not have Part A yet, CMS directs you to contact Social Security to apply for Medicare for the first time instead of using CMS-40B alone.
What Is CMS-L564?
CMS-L564 is the Request for Employment Information form. It is used as proof of group health plan coverage based on current employment when someone applies for Medicare during a Special Enrollment Period.
The person applying for Medicare completes Section A. The employer completes Section B with information about employment, group health plan coverage, dates, and a company official signature. CMS instructions say the completed CMS-L564 should be returned with the Part B application to Social Security.
When Are CMS-L564 and CMS-40B Used Together?
These forms often work together when someone delayed Part B because they had group health coverage through current employment, either through their own job or a spouse’s job.
Medicare.gov explains that an 8-month Special Enrollment Period can apply after employment or job-based health coverage ends, whichever happens first. Medicare also notes that COBRA or other non-Medicare coverage does not stop that 8-month clock from starting after work ends.
Important timing note
If you want Part B to start when job-based coverage ends, Medicare.gov says you generally need to sign up for Part B the month before you or your spouse plan to retire. Your coverage timing can depend on when Social Security receives completed forms.
CMS-L564 vs. CMS-40B: Simple Difference
CMS-40B asks for Part B
This is the application that says you want to enroll in Medicare Part B.
CMS-L564 proves coverage
This supports your Special Enrollment Period by documenting employer group health coverage based on current employment.
How MedigapRx Helps You Think Through the Forms
MedigapRx does not replace Social Security, Medicare.gov, or your employer benefits department. But Justin can help you understand what the forms are for, what questions to ask, and how the form timing fits into your broader Medicare transition.
We look at your age, current coverage, spouse coverage, employer size, HSA status, retirement date, and whether you already have Part A.
We help you understand whether you may be enrolling during an Initial Enrollment Period, General Enrollment Period, or Special Enrollment Period.
We explain which form is completed by you, which section is completed by the employer, and why dates need to be accurate.
Once Part B timing is clear, we help compare Medicare Advantage, Medigap, and Part D options based on your doctors, prescriptions, location, and budget.
Common CMS-L564 and CMS-40B Mistakes to Avoid
- Waiting until employer coverage is already ending to start the Medicare conversation
- Assuming COBRA protects you the same way active employee coverage does
- Using dates that do not match employment or coverage records
- Forgetting that the employer must complete Section B of CMS-L564
- Submitting CMS-40B without the documentation needed for the enrollment period you are using
- Missing the 8-month Special Enrollment Period after work or job-based coverage ends
- Ignoring HSA contribution issues before enrolling in Medicare
- Choosing a Medicare plan before checking doctors, prescriptions, pharmacies, and ZIP code
What If Your Employer Is Slow to Complete CMS-L564?
Start early. CMS-L564 requires employer information, and some HR departments need time to complete it correctly. If you are close to retirement or already leaving coverage, ask your employer or benefits administrator about the correct dates for employment and group health plan coverage.
If your employer cannot complete the form quickly, contact Social Security for guidance on what documentation may be accepted in your situation. MedigapRx can help you organize questions to ask, but Social Security makes the final enrollment determination.
Helpful Medicare Links
MedigapRx Locations We Serve
MedigapRx is based in Fort Lauderdale, Florida and provides Medicare guidance in states where Justin Scheiner is licensed. Plan availability, provider networks, drug coverage, and enrollment options can vary by state, county, ZIP code, carrier, and individual situation.
Broward County, Palm Beach County, Miami-Dade County, Martin County, Fort Lauderdale, Boca Raton, Hollywood, Pompano Beach, Plantation, Weston, Miami, and nearby communities.
Medicare support for clients in New York City, Long Island, Westchester, and across the state where licensed.
Remote Medicare review support for New Jersey clients comparing coverage by county, doctors, and prescriptions.
Medicare help for clients turning 65, working past 65, retiring, or reviewing coverage in Connecticut.
Guidance for South Carolina residents comparing Medicare Advantage, Medigap, and Part D options.
Medicare planning support for Georgia clients and families helping a parent with coverage decisions.
Medicare review support for Colorado clients evaluating plan networks, drug coverage, and enrollment timing.
Related MedigapRx Resources
CMS-L564 and CMS-40B FAQ
Do I always need CMS-L564 to enroll in Part B?
No. CMS-L564 is commonly used when you are applying for Part B during a Special Enrollment Period after having group health plan coverage based on current employment.
Who completes CMS-L564?
The person applying for Medicare completes Section A. The employer completes Section B and signs the form.
Who uses CMS-40B?
CMS-40B is used by people who already have Medicare Part A and want to enroll in Medicare Part B.
Can COBRA protect me from missing the Part B Special Enrollment Period?
Do not assume that. Medicare.gov says the 8-month Special Enrollment Period starts when work ends, even if you choose COBRA or other coverage that is not Medicare.
Can MedigapRx submit these forms for me?
MedigapRx can help you understand the Medicare timing and organize the form conversation. Social Security processes Medicare enrollment forms and makes final enrollment decisions.
About Justin Scheiner and MedigapRx
Justin Scheiner is a licensed Medicare advisor and founder of MedigapRx in Fort Lauderdale, Florida. MedigapRx helps people compare Medicare Advantage, Medicare Supplement, Medigap, Part D prescription drug plans, and employer-to-Medicare transitions based on doctors, prescriptions, location, timing, and budget.
Leaving Employer Coverage After 65?
Before you submit Medicare forms or choose a plan, talk with MedigapRx about your timing, current coverage, doctors, prescriptions, and next steps.
MedigapRx is not connected with or endorsed by the U.S. government or the federal Medicare program. We do not offer every plan available in your area. Please contact Medicare.gov, 1-800-MEDICARE, or your State Health Insurance Program to get information on all your options.
This article is educational and does not replace guidance from Social Security, Medicare.gov, your employer, your tax advisor, or legal counsel. Medicare rules, form instructions, plan availability, and enrollment timing can vary by individual situation.