top of page
  • Tangerine Foundation

What About Medicare?

Key Points:

  • What is Medicare Part B?

  • How Medicare Works With Primary Insurance

  • Key Forms to Fill Out For Medicare Benefits

What is Medicare Part B? Do You Need It?

Medicare Part B covers your medical expenses, including doctors’ visits, labs and X-rays, medical equipment, preventative services, rehabilitation services, mental health services, and ambulance costs.

It is offered at a low monthly premium, but the premium could be higher if your income is above a certain amount or if you are required to pay a late-enrollment penalty. You should sign up for Medicare Part B as soon as you become eligible or when another type of healthcare no longer covers you.

If you do have healthcare, you should check with your providers to see how Medicare Part B will work with your current plan.

Medicare Part B is not free; it has monthly premiums deducted from your Social Security check or your retirement check. You do not have to take Part B if you do not want it, and your FEHB (Federal Employees Health Benefits) plan cannot require you to take it…although there are some advantages to doing so, such as the coordination of benefits between Medicare and your FEHB plan that reduce your out-of-pocket costs. You should also be aware that, in certain circumstances, there can be a penalty if you do not enroll in Part B during your initial enrollment period. Coverage details are available here.

Do I Need to Sign Up for Medicare if I am Still Working at 65?

Under current rules, if your employer has 20 or more employees, you do not have to enroll in Medicare if you do not want to. Your employer’s group plan is the primary payer, which means they pay first on any healthcare bills you have. You can delay enrollment into Medicare until you retire and stop actively working.

Signing up for Medicare while still working can be tricky. Get the facts here.

If you work for a smaller company with fewer than 20 employees, you must sign up for Medicare as soon as you are eligible. With small companies, Medicare is the primary payer. If you do not sign up but stick with your group plan, the group plan can refuse to pay your claims. Even worse, when you finally sign up for Medicare, you will be faced with late enrollment penalties.

However, if you work for a large company, you can still choose to drop your employer coverage and sign up for Medicare. You need to compare the premium costs and coverage under both to see, which is better for you.

If you keep your large employer group coverage, you will have a special enrollment period after leaving your job. You can sign up for Part A, Part B, Part D, and a Medigap plan if you like, without penalty, during that time.

If You Continue to Work Past Age 65, Is Your FEHB Coverage Still Primary?

Your FEHB coverage will be your primary coverage until you retire. If you have retired with FEHB and Medicare Coverage and are also covered under your spouse's insurance policy through work, your spouse's policy is your primary coverage. Medicare will pay secondary benefits, and your FEHB plan will pay a third.

How to Fill out Form CMS-L564

The Social Security Administration’s (SSA) form CMS-L564 is an employment verification form. The purpose of this form is to apply for a Special Enrollment Period (SEP) for Medicare that is outside the Initial Enrollment Period (IEP) and the General Enrollment Period (GEP).

Your IEP is seven months long. It begins three months before your 65th birthday or the 25th month of your disability and ends three months after your 65th birthday, and the GEP is every year from January 1 to March 31.

What is CMS-L564?

This form is called “Request for Employment Information.” This form needs to be filled out by the current employer that you get your health insurance from, whether it is yours or your spouse’s. The form asks for your (or your spouse’s) dates of employment and healthcare enrollment dates.

In addition to the CMS-L564, you also need to fill out the Medicare B application form CMS-40B to be granted a SEP. If your employer is unable or unwilling to fill out the form, contact the SSA for other forms of evidence, you could provide.

Once the CMS-L564 is filled out, you need to take it to your local Social Security Office.

What is the purpose of this form?

To apply for Medicare in a Special Enrollment Period, you must have or had group health plan coverage within the last eight months through your or your spouse’s current employment. People with disabilities must have large group health plan coverage based on your spouse’s or a family member’s current employment.

This form is used for proof of group health care coverage based on current employment. This information is needed to process your Medicare enrollment application. The employer that provides the group health plan coverage completes the information about your health care coverage and employment dates.

How is the form completed?

Fill out Section A and take the form to your employer. Ask your employer to fill out Section B. You need to get the completed form from your employer or request it online (L564) and include it with your Application for Enrollment in Medicare (CMS-40B). Then you send both together to your local Social Security office. Find your local office here.

Can you get a SEP?

In order to be eligible for a SEP, you need to have or be eligible for Medicare due to age or disability, have been in enrolled in an employer group health plan such as a Federal Employee Health Benefit (FEHB) or Medicare Part B for you or your spouse’s current job, and have been continuously covered by that health insurance with a lapse no longer than eight consecutive months.

If these apply to you, generally, you are granted a SEP. You need to have Medicare Part A to be eligible for Medicare Part B.


Publish Date: October 23, 2020 © Tangerine, Inc. All rights reserved. The information contained herein constitutes general information and is not directed to, designed for, or individually tailored to, any particular individual or circumstance. This article is not intended to be a client-specific analysis or recommendation. Do not use this article as the sole basis for any financial decisions. Consider all relevant information. Information should not be considered as tax or legal advice. You should consult with your tax advisor and/or attorney regarding your individual circumstances.

34 views0 comments

Recent Posts

See All


bottom of page