Form CMS – L564

If you are unable to work because of a medical condition and you have been approved for Social Security Disability benefits, you might be asked to complete a form CMS – L564 when you apply for Medicare coverage.

The form is designed for individuals applying for Medicare coverage during a special enrollment period.

To apply for Medicare during special enrollment, you must have had group health insurance coverage for the last eight months through your spouse’s current employment or your employment.

Medicare Enrollment

The form is used to show proof that you had group health care coverage during that time. Without the completed form, your Medicare enrollment information cannot be processed.

The employer who provided your group health plan coverage will complete the form and include your employment dates or the employment dates of your spouse on the form. You will fill out Part A then take the form to your employer to complete Section B. You will return the form along with CMS – 408, which is your Application for Enrollment in Medicare.

Consult With A Disability Lawyer

If you are applying for disability benefits, consult with a disability attorney. With the help of an attorney your odds of having your claim approved increase significantly.

The disability claims process is challenging, so get your free case review with a Social Security attorney today.