Who fills out Form CMS-L564, and where do I send it once it's completed?

Question

Evan Howard · Accepted Answer

You fill out the top section (Section A) of Form CMS-L564 with your personal information. Your employer then completes the bottom section (Section B), verifies your employment and group health coverage, and signs the form before returning it to you.

Once completed, you submit the form to Social Security, generally along with Form CMS-40B, to enroll in Medicare Part B.

You can submit the paperwork in person, by fax, or by mail. I prefer submitting it in person when time is important because it gives you an opportunity to explain the urgency directly to a Social Security representative and make sure your paperwork has been received. While this doesn’t guarantee faster processing, it may help you identify any issues immediately.

Faxing is another good option because it’s faster than mailing and provides a transmission confirmation showing that you sent the paperwork. Mailing is usually the slowest option, but it can still get the job done. Just allow plenty of time for delivery and processing.

Ann Sanfelippo · Answer

Form CMS-L564 is used to verify employer-sponsored health coverage when applying for Medicare Part B through a Special Enrollment Period. Your employer or former employer completes the employment and health coverage information in Section B, while you complete Section A. Once completed, submit the form along with Form CMS-40B (Application for Medicare Part B) to the Social Security Administration, either online, by mail, or through your local Social Security office. If your employer is no longer available to complete the form, Social Security may accept alternative proof of coverage, such as insurance cards, pay stubs, or tax documents.

Answered by Ann Sanfelippo on October 8, 2026

Broker Licensed in FL, AL, AZ & 14 other states

Answered by Ann Sanfelippo Medicare Insurance Agent

Michael Wehner · Answer

Form CMS-L564 is the required form to prove you had employer group coverage as your reason for delaying your Medicare Part B coverage. The form has 2 sections. The top section (Section A) is to be filled out by the Medicare Beneficiary. The bottom section is to be filled out by the employer and then signed by a company official. The form can be faxed, mailed or dropped off at a local social security office. It can also be uploaded if you are applying for your Part B coverage online at ssa.gov.

Answered by Michael Wehner on October 7, 2026

Agent Licensed in IN, KY, NC, OH, PA & SC

Answered by Michael Wehner Medicare Insurance Agent

Jen Reas · Answer

There is a section for you (the applicant) and a section for your employers' human resources department to complete. Then you submit it to your local Social Security Office with your Part B application.

Answered by Jen Reas on October 7, 2026

Agent Licensed in MT

Answered by Jen Reas Medicare Insurance Agent

Who fills out Form CMS-L564, and where do I send it once it's completed?

Agents: Share Your Expertise

Seniors: Ask a Question of Your Own

Related Questions

Agent Locator

Medicare Agents Hub
A non-government resource website

Who fills out Form CMS-L564, and where do I send it once it's completed?

Agents: Share Your Expertise

Seniors: Ask a Question of Your Own

Related Questions

Agent Locator

Medicare Agents HubA non-government resource website

Medicare Agents Hub
A non-government resource website