Enrolling in Medicare A and B (more than 3 months past 65th birthday)

Medicare Enrollment

Enrolling in Part A & B after your 65th Birthday

Who This Applies to

Individuals over age 65 who are enrolling in Medicare Part A and Part B for the first time after previously delaying enrollment due to employer or group health coverage.

Before You Apply for Medicare

Since you did not enroll in Medicare Parts A and B when you first became eligible, you’ll need to show proof that you had creditable health coverage starting from your 65th birthday.

To do this, you’ll need the Request for Employment Information form.

Step 1: Send this form to your employer to complete.

📌 Important: If both you and your spouse are applying for Medicare, each of you must submit your own completed form.

- - - The form must be filled out by the employer that provided the health insurance coverage
    - See the section below for guidance on how to fill out this form correctly.

Step 2: Receive Completed Form

Once your employer returns the completed form, you’re ready to apply for Medicare Part A & B.

Step 3: Apply for Medicare Online

1. 1. Go to https://www.ssa.gov/medicare/sign-up
    - - Scroll down to “Sign up for Medicare” and click “Apply online”
  2. In the Notes/Comments Section at the end of the application, write:
    - - “I would like my Medicare Part B to be effective __/01/202_. I have completed a CMS-L564 form signed by my employer. I will upload this form to my SSA.gov account.
  3. Upload your Employer Form via your SSA.gov account::
    1. - Log in at ssa.gov/myaccount using ID.me or Login.gov.
  4. Go to Upload Documents (dashboard card or ssa.gov/updocs).
    - Select Other Document → Document Category: Health Insurance and Medicare → Document “Employer Proof of Current Health Insurance Coverage”.
    - Upload your Request for Employment Information CMS-L564 form and save the confirmation page for your records.

After You Apply

1. Save all confirmation emails and submission receipts
2. Regularly log in to mySSA.gov to track the status of your application
  - ➡️ How to find your Medicare Number Online
3. If a Medicare Number is not processed in your account before your requested effective date, contact your local Social Security office to confirm they received your application

Request for Employment Information Form

Frequently Asked Questions

Who Needs to Complete the Form?
Take the form to your (or your spouse’s) Human Resources or Benefits Department for completion.

A separate form is needed for each spouse applying for Medicare.

The employer must be the one that provided the group health coverage — even if that’s not the current or shared employer.
What is the purpose of the form?
The purpose of the form is to verify you have had other, creditable coverage since becoming Medicare eligible at 65. The form confirms:

The dates you (or your spouse) were actively employed.

The start date of your group health plan coverage.

🔍 Important: The coverage start date should reflect your original enrollment in employer-sponsored health insurance — not a later reenrollment date.
I've Had Multiple Employers Since Turning 65
I Can't Get the Form Signed