Chaperone Health Insurance Plus
CMS-L564 and CMS-40B: Medicare Forms for Working Past 65
Reviewed October 2026
If you kept working past 65 and stayed on your job’s health plan, you probably signed up for Part A and put off Part B. That’s often a smart move, but when the job or the coverage ends, Social Security needs two forms before it will add Part B without a penalty: the CMS-40B, which is your Part B application, and the CMS-L564, which your employer fills out to confirm your coverage. Small mistakes on either one, like a missing date or the wrong start month, can delay your coverage or leave you with a gap.
I’m Roxroy Ashley, an independent licensed agent with HealthMarkets, based in Fort Lauderdale. I’ve spent 14 years in insurance and the last 8 focused on Medicare, and helping people leave employer coverage and move to Medicare is a big part of my work. This guide explains what each form is, who needs it, how to send it, and what to do when your employer can’t help. When you’d like a second set of eyes on your forms and your timing, book a free plan review and I’ll get back to you personally within 24 to 48 hours.
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Your Part B start date sets the clock on your other Medicare choices, so before you send anything, I check:
- Your last day of employer coverage and a Part B start date that leaves no gap
- Your CMS L564 form and CMS-40B for missing dates or signatures
- Your full-year cost, not only the premium
If anything is unclear, I call your doctor’s office to confirm it. Your quote is free, with no obligation to enroll. Get your free quote and I’ll do the research for you.
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Why Choose Me to Help With Your CMS-L564 and CMS-40B Forms
When you’re signing up for Part B after working past 65, here’s what to look for in an agent, and what you can expect from me.
Your Timing Planned First: Before you fill out anything, I’ll confirm your last day of employer coverage and help you choose a Part B start date that leaves no gap, keeping your Medigap and Medicare Advantage enrollment windows in mind.
A Second Look at Your Forms: I’ll walk you through each section of the CMS-40B and CMS-L564 and help you double-check the dates and signatures before you send them, or before you upload them online.
Your Doctors, Hospitals, and Prescriptions Checked First: Once your Part B date is set, the next step is choosing the rest of your coverage. Before I recommend any plan, I check your doctors, hospitals, and every prescription against its network and drug list, including your pharmacy. If something is unclear, I’ll call your doctor’s office myself.
Every Question Answered, at Your Pace: Two government forms and an eight-month deadline are a lot to sort out, and most people spend less than an hour on it. I take as long as you need, explain each piece in plain language, and answer every question until it makes sense. There’s no pressure and no obligation to enroll.
The Plan That Costs Less for You: The lowest premium isn’t always the lowest cost. I calculate your full-year cost for every plan, including copays, drug costs, and your out-of-pocket maximum, based on your health needs, before you choose.
My Help Costs You Nothing Extra: Insurers pay my commission, and plan premiums are generally the same whether you enroll through me or directly, so you get personal guidance and ongoing support at no additional charge.
Both Paths, Side by Side: Medicare Advantage, Medigap, and Part D each work differently. I lay out every path that fits your situation and explain what you’d gain and give up with each, so you decide with the full picture.
I Handle the Paperwork, Including Your Spouse’s: If your spouse is under 65 and was on your employer plan, I also help with ACA Marketplace coverage, so your household can keep one agent through the change. If you choose a plan, I complete the application with you and follow it through to approval.
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I Stay Your Agent After You Enroll: Work with me directly, in person, by phone, on Zoom, or at your home in Broward, Miami-Dade, or Palm Beach, and I reply within 24 to 48 hours. I review your coverage every Annual Enrollment Period and help with claims and billing in between.
You can read all 25 reasons we should work together on my Why Choose Me page.
Who Needs These Forms: Medicare and Employer Coverage After 65
You generally need both forms if you delayed Part B because you had a group health plan based on current employment, either your own job or your spouse’s, and you now want to add Part B. “Current employment” means you or your spouse are actively working. It doesn’t include coverage based on retirement or disability status.
Medicare and employer coverage work together differently depending on the size of the employer. If the employer has 20 or more employees, the group plan usually pays first and Medicare pays second, which is why many people delay Part B while they’re working. If the employer has fewer than 20 employees, Medicare generally pays first, so delaying Part B can leave you with large bills your group plan won’t pick up. Ask your benefits office how your plan works with Medicare before you decide to delay.
People under 65 who have Medicare because of a disability can use a similar Special Enrollment Period, but their coverage must come from a large group health plan (generally an employer with 100 or more employees) based on their own, their spouse’s, or a family member’s current employment.
The forms also apply if you’re signing up for Part B while you’re still working, for example because your employer plan is changing or you’d like Medicare to coordinate with it. You don’t need them during your Initial Enrollment Period, the seven-month window around your 65th birthday, because you can sign up then without proving anything about employer coverage.
CMS 40B: The Application for Enrollment in Medicare Part B
Form CMS-40B is the form you use to add Part B when you already have Part A. Social Security has long called it the Application for Enrollment in Medicare Part B, and the current version from CMS, dated 07/2025, is titled Request for Enrollment in Medicare Part B (Medical Insurance). It’s two pages of questions, and you fill out and sign it yourself. If you don’t have Part A yet, the CMS 40B form isn’t the right starting point. Instead, you apply for Medicare through Social Security, and you’ll be asked for the dates of your group health coverage.
Here’s what the current CMS-40B form asks for:
Section 1, Basic Information: your Medicare number, full name, mailing address, phone number, and an optional email address.
Section 2, Enrollment in Medicare Part B: whether you’ve had employer or union group health coverage since turning 65, the dates (month and year) of the employment and the coverage, and whether an employer, insurer, or anyone else asked or required you to sign up for Part B. The form points you to the CMS-L564 for your employer’s confirmation.
Coverage start date: if you’re signing up while you still have the employer coverage, or during the first full month after it ends, you can choose for Part B to start on the first day of the month you sign up or the first day of any of the next three months. Write the month and year you want.
Section 3, Signatures: you sign and date the form. If you sign with a mark (X), a witness who knows you must also sign.
Use the current version of the CMS-40B from the official CMS-40B form page. The form is in English, and Social Security offers help in Spanish at 1-800-772-1213 (press 2).
CMS-L564 Request for Employment Information: Your Employer’s Part
Form CMS-L564, the CMS-L564 Request for Employment Information, is your proof that you had group health coverage based on current employment. Without it, or another accepted proof, Social Security can’t tell whether you qualify for the Special Enrollment Period. That’s why the L564 form is the one people search for most when they’re working past 65.
Section A is yours: you fill in the employer’s name and address, your name and Social Security number, and the name and Social Security number of the employee. The employee is you if the coverage came from your job, or your spouse or another family member if it came from theirs.
Section B is your employer’s: the employer fills in the dates the person worked there and the dates you were covered by the group health plan, plus their signature, title, date, and phone number. There’s a separate part for hours bank arrangements, which are common with union plans. Give your employer plenty of time. HR departments can take a week or more to return the form L564 (some call it form CMS L564), so I suggest asking for it a month or two before your coverage ends.
If your employer can’t or won’t complete Section B: this happens when a company closes, merges, or simply doesn’t respond. Medicare says to fill out Section B yourself as best you can, but don’t sign it, and Social Security asks you to include at least one piece of secondary evidence of your coverage. Accepted proof includes income tax returns showing health insurance premiums paid, W-2s showing pre-tax medical contributions, pay stubs showing health insurance premium deductions, health insurance cards with a policy effective date, explanations of benefits from your group health plan, and statements or receipts showing premium payments. If you apply online, Social Security also accepts a written notice from your employer or group health plan, such as a letter, fax, or email, as your proof of coverage.
You can download the current CMS-L564 from the official CMS-L564 form page.
The Part B Special Enrollment Period and Your Start Date
The Part B Special Enrollment Period lets you sign up without the Part B late enrollment penalty. You can use it any month you’re still covered by the group plan based on current employment, and for 8 months after the employment or the coverage ends, whichever happens first. The 8 months begin the month after that end date.
Your start date depends on when you sign up:
While you’re still covered, or in the first full month after coverage ends: you can choose for Part B to start the first day of the month you sign up, or the first day of any of the next three months.
Later in the 8-month window: Part B generally starts the first day of the month after you sign up.
The safest approach is to send your forms before your employer coverage ends and ask for Part B to start the first day of the month after your last day of coverage. For example, if your employer plan ends June 30, you’d ask for Part B to begin July 1. That way there’s no gap.
Your Part B start date matters for more than Part B. Your six-month Medigap Open Enrollment Period begins the month you’re 65 or older and your Part B starts, and that’s generally when you can buy any Medigap plan sold in your area without health questions. You also generally have two full months after the month your employer coverage ends to join a Medicare Advantage or Part D plan. If you miss the 8-month window, you’d have to wait for the General Enrollment Period, January 1 to March 31, with coverage starting the month after you sign up, and you may owe a late enrollment penalty. That penalty is 10% of the standard Part B premium for each full 12-month period you could have had Part B but didn’t, and it usually lasts as long as you have Part B. For reference, the 2026 standard Part B premium is $202.90 a month.
How to Submit the CMS-40B and CMS-L564 Forms
Social Security processes Part B enrollment, so your forms go to Social Security, not to Medicare or to an insurance company. As of October 2026, you have four ways to send them:
Online: if you already have Part A and you’re using the Special Enrollment Period, you can use Social Security’s online Part B application for a Special Enrollment Period. You complete the CMS-40B and CMS-L564 information online and upload your proof of coverage. You’ll need an email address to sign electronically. This is usually the fastest option, and it gives you a confirmation.
Fax: fax the signed CMS-40B and the CMS-L564 (or your secondary evidence) to your local Social Security office. Get the fax number from the office directly, and keep the fax confirmation page.
Mail: mail the forms to your local Social Security office. I suggest sending copies of your evidence instead of originals, and using a mailing method you can track.
In person: bring the forms to your local Social Security office. You can find yours with the Social Security office locator, and calling 1-800-772-1213 (TTY 1-800-325-0778), Monday through Friday from 8 a.m. to 7 p.m., to ask about appointments can save you a wait.
Whichever way you choose, keep a copy of everything you send, and write down the date you sent it. Your Part B application date matters if there’s ever a question about your timing. After Social Security processes your application, you’ll get a letter confirming your Part B start date, and your Medicare card will show it. If you get Social Security benefits, your Part B premium is usually taken out of your benefit. If you don’t, Medicare will bill you.
Common Mistakes When Signing Up for Part B After Working Past 65
Counting on COBRA: COBRA isn’t coverage based on current employment, so it doesn’t extend your Special Enrollment Period. Your 8 months start when your job or active coverage ends, even if COBRA continues after that. This is one of the most expensive mistakes I see. My COBRA and Medicare guide explains how the two fit together.
Counting on retiree coverage: retiree health plans also don’t count as current employment coverage. If your only coverage after 65 is a retiree plan, you generally need Part B to avoid a penalty, and many retiree plans expect you to have it.
Signing up with severance coverage too late: if your group coverage continues because of severance or retirement pay, the 8-month clock still generally starts when the job ends, not when that coverage ends.
Leaving dates blank: missing employment or coverage dates on the CMS-40B or L564 is a common reason for delays. Check that the dates on both forms match.
Forgetting the start date: if you don’t write the start month you want, you may get a different date than you planned. Put it in writing.
Waiting too long to ask your employer: HR departments can be slow, especially after you’ve left. Ask for the CMS-L564 before your last day.
Contributing to a Health Savings Account: you can’t contribute to an HSA once you have any part of Medicare, and Part A can start up to six months before you apply, but not before the month you first became eligible. Social Security suggests stopping HSA contributions at least six months before you apply. I can’t give tax advice, so check with your tax advisor about your own situation.
Dropping employer coverage before Medicare is confirmed: wait until you have your Part B start date in writing before you cancel anything.
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Frequently Asked Questions About CMS-L564 and CMS-40B Forms
What Is Medicare Form L564, and Who Fills It Out?
Medicare form L564, officially the CMS-L564 Request for Employment Information, confirms that you had group health coverage based on current employment. You complete Section A, and your employer (or your spouse’s employer) completes and signs Section B. You then send it to Social Security with your CMS-40B, or upload it with Social Security’s online Part B application.
Where Can I Download the CMS L564 Form PDF?
Download it directly from CMS, so you know you have the current version: the CMS-L564 PDF and the CMS-40B PDF. Many third-party sites offer copies of these forms, but some are outdated or ask you to create an account or pay to download. The official forms cost nothing. If you’d prefer to skip the paper, Social Security’s online Part B application covers both forms.
I’m Working Past 65. Do I Need Medicare Right Now?
It depends on your employer’s size and your coverage. For working past 65, Medicare generally lets you delay Part B without a penalty if you have group coverage based on current employment, and most people still take Part A because they don’t pay a premium for it. If your employer has fewer than 20 employees, Medicare usually pays first, so you may need Part B right away. If you contribute to an HSA, taking Part A affects that too. My Turning 65 Medicare Checklist walks through each step.
How Long Does Social Security Take to Process the CMS-40B?
Processing times vary by office and how you apply. Online applications are often faster than fax or mail, but it can still take several weeks. That’s why I suggest sending your forms before your employer coverage ends and asking for a future start date. You can check on your application by calling Social Security at 1-800-772-1213 (TTY 1-800-325-0778).
What Happens If I Miss the 8-Month Special Enrollment Period?
You’d generally have to sign up during the General Enrollment Period, January 1 to March 31, with Part B starting the month after you sign up. You may also owe a late enrollment penalty of 10% of the standard Part B premium for each full 12-month period you went without Part B, which usually lasts as long as you have Part B. If you think you missed your window because of incorrect information from an employer or another special situation, Medicare has other limited Special Enrollment Periods that use Form CMS-10797, so it’s worth asking.
My Spouse Is the One Still Working. Do I Still Need the L564?
Yes. If your coverage came through your spouse’s current employment, your spouse’s employer completes Section B, and your spouse is listed as the employee in Section A. Your Special Enrollment Period is based on when your spouse’s job or the coverage ends, whichever comes first.
Do I Need These Forms to Join a Medicare Advantage or Medigap Plan?
No. The CMS-40B and CMS-L564 only get you enrolled in Part B through Social Security. You need both Part A and Part B to join a Medicare Advantage plan or buy a Medigap plan, which are separate applications with the insurance company. Medicare Advantage is a different way to get your Part A and Part B benefits, while Medigap works alongside Original Medicare, so I’ll explain both before you choose.
Where Can I Get More Help With Medicare Enrollment?
Social Security handles Part B enrollment at 1-800-772-1213 (TTY 1-800-325-0778), Monday through Friday from 8 a.m. to 7 p.m. For general Medicare questions, you can call 1-800-MEDICARE (TTY users should call 1-877-486-2048), 24 hours a day, 7 days a week. In Florida, you can also get free Medicare counseling through the state’s SHIP program, called SHINE. And I’m glad to help you with your forms and your plan choices at no extra cost.
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