You filled in your part of CMS-L564 and handed it to your employer. Then nothing happened. Or HR says they don't sign government forms. Or the company has closed.
Social Security has rules for exactly this. You can still prove your coverage and sign up for Part B. You just use a different kind of proof.
Don't let a slow employer run out your clock
Your request to enroll has to be filed during your enrollment period (42 CFR 407.22). If your 8-month window is closing, use one of the options below now instead of waiting for HR.
Option 1: A letter, fax or email from the employer
Some employers won't fill out the form but will write a short letter. Social Security's manual says a field office can accept a letter, fax or email from the employer or the health plan as evidence (POMS HI 00805.295). It must come from a company or plan official and include:
- the official's title,
- the official's phone number or other contact information, and
- the date.
It also has to show when you had coverage based on current employment and, if it ended, when it ended. You can make this easy by giving HR a sentence to use, such as: "[Your name] was covered under our group health plan as a current employee (or the spouse of one) from [mm/yyyy] to [mm/yyyy]."
If the holdup is the signature itself, tell HR that Section B doesn't need a handwritten signature. Electronic, stylus and rubber-stamp signatures are all acceptable.
Option 2: Ask the health plan
Social Security's manual says Section B can be completed by the employer or the group health plan (POMS HI 00805.295). If HR won't help, contact the insurance company or plan administrator. They can complete Section B or send a letter with the same details.
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Option 3: Fill in Section B yourself, don't sign it, and add proof
Both Social Security and Medicare.gov describe this route. Complete Section B as best you can on your employer's behalf, but don't sign it. Then attach secondary evidence of your job-based coverage (SSA Publication 05-10043).
Social Security lists these types of secondary evidence:
| Document | Why it helps |
|---|---|
| Income tax returns that show health insurance premiums paid | Shows you paid for health coverage in a given year |
| W-2s reflecting pre-tax medical contributions | Ties health coverage to the job, year by year |
| Pay stubs that reflect health insurance premium deductions | Shows coverage through payroll; your last stubs help show when it ended |
| Health insurance cards with a policy effective date | Helps show when coverage started |
| Explanations of benefits paid by the group health plan | Shows the plan was paying claims on certain dates |
| Statements or receipts that reflect payment of health insurance premiums | Shows premiums were being paid |
Social Security's manual says acceptable documents "include but are not limited to" this list, so other papers that show your employment and coverage may also help.
What your proof has to show
Evidence can be in any form, as long as it shows (or lets Social Security work out) two things (POMS HI 00805.295):
- when you had coverage based on current employment, and
- if it ended, when it ended.
Pick papers that cover both ends. For example, an insurance card with an effective date for the start, plus your last pay stubs with a premium deduction for the end. The proof doesn't need to show how big the employer is or whether the plan pays before Medicare.
Social Security may call your employer
Social Security can also get the facts directly. It may phone the employer or plan and write up the call, or have a staff member certify the information from the employer's records (POMS HI 00805.295). This is one more reason to put the employer's correct name and address in Section A.
More than one employer
If you had job-based coverage through more than one employer since you turned 65, Social Security needs evidence from each one. Gather proof for every employer, not just the most recent.
What doesn't count as proof
- A Part D creditable coverage letter. Social Security says it is not proof of group health plan coverage for the Part B Special Enrollment Period. That letter is about drug coverage.
- Proof of COBRA or retiree coverage. Neither counts as coverage from current work. See COBRA and Part B.
If you're self-employed
You complete Section A. The health plan completes Section B, not you (POMS HI 00805.290). If the plan won't, the same secondary-evidence options apply.
If your employer gave you wrong information
Sometimes the problem is bigger than a missing signature. If you missed your Part B window because your employer, health plan, or a plan's agent or broker gave you wrong information on or after January 1, 2023, you may qualify for an "exceptional conditions" Special Enrollment Period. You apply with form CMS-10797. For this one, CMS-L564 isn't required, and a written, signed statement from you can be enough evidence (POMS HI 00805.384). It lasts 6 months from the day you tell Social Security.
Sending it in
Send your signed CMS-40B, the L564 with your unsigned Section B (or the employer's letter), and your proof together. Keep copies of everything. See how to submit the forms.