• Question
  • Employer certification of private insurance in lieu of Part B coverage.

    Asked on 6/8/2012

    Where do I find the Form for my employer to certify that I have had private group coverage instead of Part B coverage since I turned 65?

  • Categories: Employer Coverage & Medicare, Health Care and Health Insurance


  • Editorial 


    San Francisco, CA

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  • Finding and keeping up with all the right forms and enrollments for healthcare is difficult. I searched and searched and think I may have found the information you are seeking.....

    This is from the http://www.medicarerights.org web site.

    -- http://www.medicarerights.org/PartB-Enrollment-Toolkit/PartB-Special-Enrollment-Period.pdf

    I hope it is useful!

    How to Obtain a Part B SEP
    To obtain an SEP to enroll in Part B, contact the Social Security Administration at 800 772 1213 and request the following two forms:

    - CMS 40B (Application for Enrollment in Medicare)
    - CMS L564 (Request for Employment Information)

    Fill out and sign forms with your employer. Once complete bring forms to your local Social Security office.

    The purpose of this form is to provide documentation to Social Security that proves that you have been continuously covered by a group health plan based on current employment, with no more than eight consecutive months of lapses in coverage.

  • Login to rate this answer:   Answered on 6/8/2012
**All above answers are provided as general information only. No warranty is made regarding the fitness or accuracy of the information provided in this answer. You should seek advice from a licensed CPA, attorney or CERTIFIED FINANCIAL PLANNER™ as to your unique financial situation.