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CMS-L564 2020 4.8 Satisfied (234 Votes)
CMS-L564 2016 4.3 Satisfied (100 Votes)
CMS-L564 2010 4.4 Satisfied (139 Votes)
CMS-L564 2000 4 Satisfied (26 Votes)
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Send your completed and signed application to your local Social Security office. If you sign up in a SEP, include the CMS-L564 with your Part B application. If you have questions, call Social Security at 1-800-772-1213. TTY users should call 1-800-325-0778.
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.
You can complete form CMS-40B (Application for Enrollment in Medicare \u2013 Part B [Medical Insurance]) and CMS-L564 (Request for Employment Information) online. You can also fax the CMS-40B and CMS-L564 to 1-833-914-2016; or return forms by mail to your local Social Security office.
To sign up for Part B using a Special Enrollment Period, you'll also need to fill out and submit an Application for Enrollment in Part B (CMS-40B) form at the same time.
Fill out Form CMS-40B (Application for Enrollment in Medicare Part B). Send the completed form to your local Social Security office by fax or mail. Call 1-800-772-1213. TTY users can call 1-800-325-0778.
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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 can also fax the CMS-40B and CMS-L564 to 1-833-914-2016; or return forms by mail to your local Social Security office. Please contact Social Security at 1-800-772-1213 (TTY 1-800-325-0778) if you have any questions.
Send your completed and signed application to your local Social Security office. If you sign up in a SEP, include the CMS-L564 with your Part B application. If you have questions, call Social Security at 1-800-772-1213. TTY users should call 1-800-325-0778.
You can apply online or you can mail your completed CMS 40B, Application for Enrollment in Medicare - Part B (Medical Insurance) to your local Social Security office.
This form is your application for Medicare Part B (Medical Insurance). You can use this form to sign up for Part B: During your Initial Enrollment Period (IEP) when you're first eligible for Medicare. During the General Enrollment Period (GEP) from January 1 through March 31 of each year.

medicare form cms l564