What is the CMS-L564 form and when do I need it for Medicare enrollment?

Question

Felicia Davis · Accepted Answer

The CMS-L564 — “Request for Employment Information” is a Medicare form used primarily when someone delayed Medicare Part B because they had employer-sponsored group health coverage based on current employment. It proves to Social Security that you had qualifying coverage, which can allow you to enroll in Part B during a Special Enrollment Period (SEP) and generally avoid a Part B late-enrollment penalty.

Answered by Felicia Davis on October 8, 2026

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Casey Ahlbum · Answer

Seniors who are still working and covered by a large group plan can delay starting Part B and enroll, without penalty, if they've maintained proof of continuous creditable coverage.

The CMS-L564 form is used to document creditable coverage; it is signed by a representative of the employer, and is submitted with the application for Part B.

For many seniors, it can make sense to delay starting Part B, and the CMS-L564 form helps avoid Part B late enrollment penalties by documenting continuous creditable coverage.

Steven A James, MBA · Answer

It's a form you may download, or Social Security sends to you. It's to verify that you've had "creditable coverage" since becoming Medicare eligible. This is typically when you first became Medicare eligible but continued working with group coverage, so only enrolled in Part A. The form is part of the process in then enrolling in Part B. Verification of this process determines whether or not a Late Enrollment Penalty (LEP) will be applicable.

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Sandra Teel · Answer

If you decide to work past the age of 65, you will need to fill out the L-564 form and submit it to Social Security when you apply for your Part B. The L-564 form is filled out by your employer and shows that you've had "creditable coverage" by your employer since you turned 65. This is a very important document to submit because it will keep you from having to pay a late penalty.

Answered by Sandra Teel on May 4, 2026

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Terry Salak · Answer

This form is to be filled out and submitted with your Medicare Part B application IF you chose to work, and receive creditable medical benefits, through an employer. This form is filled out by your HR department showing that you've had creditable coverage past the age of 65 and prevents Medicare/SSA from charging you a late enrollment penalty on your Medicare Part B.

Answered by Terry Salak on May 5, 2026

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Voss Speros · Answer

The question today is, what is the CMS-L564 form and when do I need it when enrolling for Medicare?

The CMS-L564 form is to prove you had employment coverage. When you're retiring from work, or you're leaving work, or you're dropping your work plan and you're going on Part B, it's after 65. After 65, you missed 65, you put off, postponed your Part B because you're working and using your work insurance. After 65, you're now going to leave work and you need to prove that you had group coverage and you were eligible for that coverage. So when you go on Part B, you don't have to pay penalties. No one wants a Part B penalty because it's up there.

So when you're retiring, you get this form. You get your Part B form, fill that out, and you get this form and submit that, and then you get your employer to sign off saying yes, I had coverage, and boom, you go on Part B, no penalties.

If you have any questions, give us a call. We're more than happy to answer your questions. Thank you.

Elisa Peinado · Answer

The CMS-L564 is needed when you are ready to enroll in Part B of Medicare. You will need to show proof of creditable coverage from your employer.

This form is usually required if you wait to enroll in Part B coverage because you are covered under employer benefits.

If you need help, please reach out to us; we're happy to help guide you.

Maricela Cisneros · Answer

Form CMS-L564 is an official Medicare form. This form is the form the employer would need to sign and fill out to show proof an employee indeed had (creditable) medical coverage during a time that employee should have been enrolled on Medicare. This form essentially clears any potential penalties due to not enrolling on Medicare A & B when first eligible.

Answered by Maricela Cisneros on August 10, 2026

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Answered by Maricela Cisneros Medicare Insurance Agent

Jerrid Ehlinger · Answer

Official proof of employer-sponsored group health coverage. It is required to qualify for a Medicare Special Enrollment Period (SEP) and avoid late enrollment penalties when delaying Medicare Part B while actively working.

Answered by Jerrid Ehlinger on May 26, 2026

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Edward MacConnell · Answer

The CMS-L564 is important to show that you had creditable employer coverage. This permits you to enroll on Part B at a later date without having to pay a late entrant penalty on your Part B premium.

Gary Church · Answer

The CMS-L564 form is an employment document used to verify employment at the time of Medicare enrollment. It is specifically for individuals aged over 65 who need to demonstrate they had creditable coverage to avoid a penalty.

Answered by Gary Church on May 5, 2026

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Michelle de Guzman · Answer

CMS Form L564 is the form you file if you were on employer-based creditable healthcare coverage after you turned 65. This could be your employer or your spouse's employer. This form is signed by Human Resources verifying your date of termination of that plan. Therefore, you file this shortly before you leave that plan, i.e., when you or your spouse retires.

Answered by Michelle de Guzman on July 27, 2026

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Sherita Joseph · Answer

It’s the form that proves you had work insurance after 65 so Medicare won’t charge you a penalty when you sign up for Part B later.

Ana V. Magalhaes · Answer

Hi,

It’s a form related to coverage through employer and needed to provide to CMS in order to enroll in Part B without paying a penalty fee.

Jack Mayer · Answer

It shows proof of Group Employee Health Coverage, and you can obtain the form through Medicare.gov or from the SSA in person or online.

What is the CMS-L564 form and when do I need it for Medicare enrollment?

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What is the CMS-L564 form and when do I need it for Medicare enrollment?

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