Use this form to show proof of group health plan coverage based on current employment for Medicare enrollment by completing Section A yourself and having your employer fill out Section …

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.

Get the forms you need to sign up for Part B including CMS-40B, CMS-L564, CMS-10797, and CMS-10798.

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 …

Learn how to fill out Medicare forms CMS-L564 and CMS 40-b. This guide offers essential insights for beneficiaries to simplify the process.

Nov 28, 2023 · In this article... You need to submit a CMS-L564 form along with your application for Medicare if you enroll during a qualifying Special Enrollment Period. Learn what you need to …

Mar 21, 2025 · To prove your eligibility for an SEP, you must fill out and send Form CMS-L564 with your application. This form provides information about your or your spouse’s employment …

Dec 16, 2025 · Learn how to correctly handle the applicant and employer sections of the CMS-L564 for SSA verification. The CMS-L564 form, “Request for Employment Information,” is a …

Use this form to show proof of group health plan coverage based on current employment so you can enroll in Medicare. You complete Section A of this form, then ask your employer to fill out …

Dec 2, 2025 · Download the current cms-l564 form directly from the Centers for Medicare & Medicaid Services website at cms.gov/cms-l564-request-employment-information. Always …