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Unlocking Medicare Knowledge: What is Form CMS-L564?

2 mins read
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Understanding the various requirements of the Medicare enrollment process can be complex, especially when the status of employment factors into the equation. A critical element in this context is the CMS-L564 form, a document that often comes into play for those who delay enrolling in Medicare due to ongoing employment. 

In this article, we explore the intricacies of form CMS-L564 and its significance for individuals who opt to postpone their Medicare enrollment while employed. Understanding this form and its application is vital for a smooth transition to Medicare without facing penalties or gaps in coverage. 

How Does Delayed Medicare Enrollment Work?

Delaying Medicare enrollment while employed involves a few key steps and understanding the role of Form CMS-L564 is crucial in this process. Here’s what you need to know:

  • Understand Your Eligibility: Typically, Medicare enrollment eligibility begins three months before you turn 65. If you’re still employed at this stage and covered under your employer’s health plan, however, you might choose to delay enrollment.
  • Communicate with Your Employer: It’s important to discuss your decision to delay Medicare with your employer or human resources department. They can guide you on how this decision interacts with your current employer-sponsored health coverage.
  • Enroll in Medicare When Coverage Changes: If you lose your job or decide to retire, you should immediately initiate the Medicare enrollment process. This is a must to make sure you avoid any gaps in healthcare coverage or potential late enrollment penalties.

Form CMS-L564: A Critical Document

Form CMS-L564 is also referred to as the ‘Request for Employment Information’. Here are the details of this form you need to pay attention to:

  1. Section A – Personal Information: The employee seeking delayed Medicare enrolment must fill this section. It requires basic personal information, including your name, Social Security Number, and Medicare Number (if you have one).
  2. Section B – Employment Information: This section confirms your employment and health insurance coverage details. The employer fills this section. Key information includes:
  • Dates of your health insurance coverage.
  • Verification that you were actively working during the time of health insurance coverage, which justifies the delayed enrollment in Medicare.
  1. Submission and Processing: Once completed, this form accompanies your Medicare enrollment application. It acts as proof that you had health insurance through an employer and were eligible to delay Medicare enrollment without penalty.

Remember, prompt completion and submission of Form CMS-L564 is vital. It facilitates smoother processing of your Medicare application and also helps in avoiding unnecessary delays or complications in gaining Medicare coverage after your employment insurance ends.

What Happens if I am Employed Beyond Age 65?

Working beyond the age of 65 has implications for your Medicare enrollment, particularly concerning the Medicare Secondary Payer (MSP) rules. Here’s a summary of how these rules apply:

  • Medicare as Secondary Payer: If you continue working past 65 and have employer-sponsored health insurance, Medicare typically acts as the secondary payer. This means your employer’s insurance plan pays first for any healthcare services, while Medicare may pay for costs the primary insurance doesn’t cover.
  • Employer Size Matters: MSP rules apply differently based on the size of your employer. For larger companies, generally with 20 or more employees, the employer’s health plan is the primary payer. For smaller companies, Medicare is usually the primary payer.
  • Enrollment Flexibility: Working past 65 gives you flexibility regarding Medicare enrollment. You can delay enrolling in Medicare Part B without facing late penalties as long as you have health coverage through your employer.
  • Special Enrollment Period (SEP): Once you retire or lose your employer coverage, you’re eligible for a SEP. This 8-month period allows you to enroll in Medicare Part B without penalty, starting the month after your employment or health coverage ends.
  • Understanding COBRA and Medicare: If you opt for COBRA coverage after employment, you must understand that it does not extend your SEP for Medicare Part B. Medicare often becomes the primary payer once you are eligible for COBRA, even if you haven’t enrolled in Medicare.
  • Avoiding Coverage Gaps and Penalties: To prevent any gaps in coverage or late enrollment penalties, it’s advisable to enroll in Medicare during your SEP. This ensures continuous healthcare coverage and avoids the risk of high out-of-pocket costs.

At CoverRight, we guide you through every step of your Medicare journey, ensuring you make the best healthcare choices with confidence and ease. Reach out to us today!

Connor Wilson

Connor is a Content Writer at CoverRight focused on editing and publishing Medicare and health insurance-related information. He also serves the team as a Business Operations Lead, working to expand the business and enhance its strategy. Prior to joining CoverRight, Connor was able to hone his knowledge of the financial services industry through his work in investment banking.

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