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Apply online (at Social Security) This is the easiest and fastest way to sign up and get any financial help you qualify for. Youll create your secure my Social Security account to sign up for Medicare or apply for Social Security benefits online.
What is the CMS-L564 form used for?
This form is used for proof of group health care coverage based on current employment. This information is needed to process your Medicare enrollment application. The employer that provides the group health plan coverage completes the information about your health care coverage and dates of employment.
What is the proof of group coverage form for Medicare?
The Form CMS-L564 is used for proof of group health plan coverage based on current employment (i.e., active coverage), which is needed to process the Medicare enrollment application.
How do I submit CMS 40B?
You will electronically sign the online application, so you will need to provide an email address. If you prefer, you can fax or mail the completed forms CMS-40B Application for Enrollment in Medicare Part B (Medical Insurance) and CMS-L564 Request for Employment Information to your local Social Security office.
What forms are needed to apply for Medicare Part B?
Fill out the Application for Enrollment in Medicare Part B (CMS-40B) (PDF). If you are applying during the Special Enrollment Period, also fill out the Request for Employment Information (CMS-L564) (PDF).
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