In this guide 5 sections
This is a Part B penalty and paperwork problem. Submit proof of job based coverage to Social Security. Qualifying months of group health plan coverage based on current employment are excluded from the penalty calculation.
Start with Social Security
Social Security handles Part B enrollment and receives the employer coverage documents. Send the completed form and supporting coverage documents to the local Social Security office.
Submit proof of the employer coverage
- 1.Ask the employer to complete Form CMS-L564, Request for Employment Information.
- 2.Send the completed form to the local Social Security office by fax or mail.
- 3.If the employer cannot complete the form, complete Section B as fully as possible without signing it and submit other proof of the job based health insurance.
- 4.Keep copies of the penalty notice, the form, the supporting proof, and anything sent to Social Security.
Check whether the coverage qualified
For someone age 65 or older, the Part B Special Enrollment Period generally requires group health plan coverage based on the current employment of the beneficiary or a spouse. The enrollment window ends eight months after the employment or group health coverage ends, whichever happens first.
When SSA or CMS can provide broader relief
If a federal employee or someone acting for the federal government gave incorrect information, failed to act, or made an error that harmed the beneficiary’s Part B enrollment rights, SSA or CMS may provide equitable relief. That relief can include adjusting premiums or enrollment dates. Missing employer proof by itself is not identified on these government pages as a separate equitable relief ground.
Why correcting the record matters
The Part B late enrollment penalty adds 10 percent for each full 12 month period when the person could have had Part B but did not. Qualifying months of current employment group health plan coverage are excluded from the penalty calculation.
Questions families ask
Should the beneficiary contact SSA or Medicare first?
Start with Social Security. Social Security handles Part B enrollment and receives Form CMS-L564 and supporting coverage documents.
What if the former employer will not complete Form CMS-L564?
Complete Section B as fully as possible without signing it, then submit other proof of the job based health insurance to Social Security.
Can CMS remove the penalty because paperwork was missing?
The cited government pages do not describe a specific CMS reconsideration process for missing employer proof. They do allow SSA or CMS to grant equitable relief when federal error, misrepresentation, or inaction harmed enrollment rights.
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