Welcome to Medicare School Daily, where we help you understand Medicare, save money,
avoid mistakes, and above all else, get the most out of your Medicare benefits. Now, today's
topic is how to fill out the Medicare forms, CMS-L564 and the CMS-40b. We now I want you
to be reminded of this, if you are looking at filling out these particular forms. The
reason for that is because you're coming into Medicare, and you have been working and now
you're coming in Medicare and you're at least 65 and 4 months old. You may be 67, 79, 82,
83, doesn't matter, but you're older than 65 and 4 months old. You didn't take Medicare
when you were first eligible at 65. Because when people come into Medicare at 65, they
come in using what we call the initial enrollment period.
And this is when you're coming in at 65 years old.
Folks, these forms are not necessary when we start Medicare at 65. In fact, this whole
process here can really be paperless, and it can be done online. But when we're going
to come into Medicare beyond 65, which meant you or your spouse were still working and
you didn't start Medicare at 65, we're going to come in using what is called a special
enrollment period. OK, so you're at least 65 and 4 months old, right? It’s the only
way you can come into Medicare without penalties and problems is by using these forms in this
particular process that I'm trying to teach you. So these are special enrollment period
documents that are necessary to start your Medicare with no penalties and no problems.
So let me explain how to fill the forms out. This first form is the L564, and you can see
it's called a request for employment information. Now, Section 8 is your responsibility. Now
iif you work with us, we'll certainly be happy to do this for you. We do them all the time.
But if you do this, you have to fill out Section 8, which is employers name, their address,
and of course, city, state, and zip. You have to have one of these filled out for every
employer that you've had since 65. So let's say you're 69 years old, and you've changed
employers since 65. You're going to have to have two of these documents filled out, because
every employer has to verify from the time you're ready to start Medicare all the way
back to 65. So that employer’s going to verify you've been working, and that you had
insurance while you were working for them.
That's the purpose of this form. OK, now when it comes to applicant employee, let's say
you're the one that is the one who's been working, and you're also the one now getting
ready to apply for Medicare, your name would be on both of these blanks. You're the applicant
and you're the employee, so your Social Security number would be listed. But let's suppose
that you're retired; you'd be covered by a spouse's work plan. Your spouse will be the
employee and you will be the applicant. So we have to have these filled out on both parties
if they're going to start Medicare. And again, we're going all the way back to 65. OK, so
that's the part that you'll fill out, or we'll do it for you if we work together. Now, this
next section is what the employer is going to fill out. There's a couple of real key
items here that I want to make very clear to you. Question number one says, Is the applicant
covered under the employer group plan? Well, the answer that is obviously going to be yes,
unless that plan's just been dropped recently. But if you're covered by a group plan, that's
what makes you eligible to come into Medicare with no penalties, no problems. So the answer
that's going to be yes. If yes, give the date, the applicant's coverage began.
So when did you start working for them? And this is a place where many H.R. departments
that have no experience with this form will make a mistake. And it says the applicant's
coverage and some people in H.R. look at that and they think that we're looking for who
is the insurance company. Say it was Blue Cross or United HealthCare or Aetna, somebody.
And they think that's the date we're looking for. When did that insurance carriers coverage
begin? That is not the question. It is when did you have coverage by the group health
plan, regardless of the insurance carrier? That's not the issue. It is how long you've
been covered by the group plan, which is typically when you started working at the company, or
if it’s your spouse, when your spouse lost their coverage and went on the group plan.
Okay, so it’s coverage, not carrier. So you’re going to be sure that they fill that
correctly, and then has the coverage ended? This could be yes or no. And now if it does
say coverage is as ended: Yes, when did it end? Because we want to make sure that you're
applying within 8 months of that particular date. If you go beyond 8 months of when the
coverage ended, you do not qualify to come into Medicare using a special enrollment period.
Now, as a practical standpoint, you're not going to use the full 8 months. And I’ve
teached on that in other videos, but you do have 8 months to come into Medicare once you've
lost the group plan.
All right? And so we want to make sure that that is not within a longer than 8 month period.
And then when the employee work for the company, obviously this when you start working and
if you're still working, they'll put the date in there of when you stopped working. All
right? So that's the part that the employer is going to fill out. And then lastly, what
we have is the place where the employer representative is going to sign this document. So it's a
signature company official. Obviously, they sign it. They're going to date it, and they're
going to put what their title is, whether it's H.R. department or vice president or
whatever, and they'll put their phone number down. Now as a practical standpoint, I want
you to know that we do not have to have a wet signature. In other words, we don't have
to have their original signature document and get that to the Social Security office.
As long as it's signed by them and dated and their information is here. If you want to
scan an email to them and they send it back to you, that is fine. Or if they were to fax
it back to you. That is certainly fine. The Social Security office does not require that
it be a wet signature; just needs to be signed by the appropriate party. All right?
So these are the two documents that we need to get to Social Security would be the L564,
and then we have the next one, which is called the CMS-40b. So let me explain how this particular
document works. This is a form that is going to take about a minute to fill out. And this
is the form where we're going to specify when we want to start our Medicare coverage. And
so your Medicare number: now, sometimes when you're filling this form out, you don't have
your Medicare number yet. You may have gone online and just applied for Medicare A and
B. And so if you have applied, you can go online about a week after the application
has been made, go to your SSA.gov account and you should be able to retrieve your Medicare
number. If you're not able to do that, you can wait until your card shows up. But from
the time you apply to when your card shows up is typically about a month. So if you want
to get this form in before then, get the information from your online account. Do you wish to sign
up for Medicare Part B? Yes, that's the purpose of this document. Last name, first name, middle
initial, your mailing address, your phone number. Now down to the bottom is the last
part. And it's actually the most important part of this form is the remarks section.
And by the way, here we're talking about a witness. You don't have a witness if you'll
read this, what it says, if you only sign your name with an X, you need a witness.
Well most of us know how to sign your name, so a witness is not necessary. But back to
the remarks. What happens here is you're actually going to pick the date that you want to start
your Medicare coverage. And let's suppose that our group plan at work ends August 31,
that means we want to start Medicare September 1. So we're going to say, please begin my
Medicare benefits effective September 1, whatever the year is. All right, so you pick the time.
If you're going to work through the end of the year, and your coverage is going to begin
December 31, and you want to start Medicare January, that's what we're going to tell them.
Please begin my Medicare January 1 of whatever year. Now, here's why it's important. Because
if you do not pick a date, what'll happen is whenever they get the form, they're going
to start you the next month. All right? So if you don't want to start the next month,
you better tell them when you want to start this. And again, you would not go on any more
than probably 60, 90 days at the most. All right? But you can go out and specify when
you want to start that. Otherwise they will start you the next month. All right? And so
these are the two forms that are necessary if we're going to come in using what is called
a special enrollment period. And remember who's going to use these?
Any one that is 65 and 4 months old on. They're coming into Medicare because at this time,
because they were already working and their spouse’s are working. And this is the paperwork
and process that's necessary for you to come in with no penalties and no problems.