Working Past 65: Delayed Medicare Enrollment

People can delay enrollment in Medicare Part B if they are working beyond their 65th birthday or are covered by their spouse’s employer health insurance. But once they want to get their Medicare started there can be some confusion.

Steps to take to get Part B:

If people plan ahead, they can take care of their delayed enrollment in Part B by mail. But everybody I have spoken with waited until the last minute and wanted their coverage to begin on the first of the next month. So they needed to move quickly to get their paperwork in order.

Katherine, who is 66, called Social Security to tell them she wants her Part B to begin on June 1st. She asked about getting the necessary paperwork on-line and was told the forms are not on the Social Security website. (I wonder why?) She was told to google the following:

CMS-40B     This form is used to apply for Part B using a special enrollment period.

CMS-L564   This form must be signed by the person’s employer to certify that he/she has had employer group health insurance.

These two completed forms can be taken to the local Social Security office and the enrollment in Part B can be in the system in just a day or two. It’s a good idea to call Social Security (800-772-1213) to see if you can make an appointment at the local office. When talking to Social Security, ask if  there are any other documents you need to provide. I have heard of some people being required to provide a birth certificate.

Part B is required to apply for Medicare Advantage or Medigap.

A person cannot submit an application for Medicare Advantage or Medigap until their Part B is in the system. Last year I worked with Fred, who waited until Monday, April 23rd to submit his forms to Social Security. He did this in-person at the local Social Security office.  Two days later, we sent in an application for a Medicare Advantage plan with a start date of May 1. I was worried the application would be rejected because his Medicare record would not show he had Part B.  My fears were unfounded because he was in the system – just two days after submitting his paperwork for Part B.

Medicare Advantage: When a person has delayed enrollment in Part B because he had employer health coverage, a specific code must be put on the Medicare Advantage application. If the wrong code is used, Medicare will reject the application. (Note to new insurance agents: This is not an IEP or ICEP.)

Medigap: A person who has had employer health coverage can get a Medicare supplement with “guaranteed issue”, no matter what his age or what health problems he has.  The Medigap application has some confusing questions that actually pertain to guaranteed issue. (Experienced insurance agents know what I’m talking about.)

I have been pleasantly surprised at how efficiently the local Social Security office performed for people who waited until the last moment to submit their paperwork for Medicare Part B.  If a person takes care of this two months before they want Part B to begin, they can receive and submit their paperwork by mail. But it seems like a lot of people are not aware of what they need to do to get their Part B started if they delayed enrollment for good reasons.

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4 Responses to "Working Past 65: Delayed Medicare Enrollment"

  1. Hi,

    I have a question regarding delivering the two forms CMS-40B & CMS-L564 to my local SS office – can that be done by my husband or does it need to be me? I thought I could upload these forms from ssa website but I can’t find any info regarding being able to do that.

    thank you for your time and help,
    Joanne

  2. Denise says:

    Your husband can deliver the forms to the Social Security office, but….  he’d better schedule a couple of hours of his time to carry out his assignment.

    I live in Tucson, AZ and I recently delivered some forms to the local Social Security office for my neighbor.  When I arrived at the Social Security office, there was a security person who told me to take a number and take a seat.  I would not have left papers with the security guard and there was no other person visible for me  to talk to  in the lobby.  So I took a seat and waited for my number to be called.

    I got lucky and waited only 15 minutes. But I was told there had been an electricity outage earlier in the day and they had told everybody to go home. When I arrived, there were very few people in the waiting room. I think the usual wait is an hour or more.

    But….. I think it’s worth it to wait and meet with a Social Security agent who will tell your husband what happens next. And he will be sure your papers got into the right hands.

    If you live in Arizona, let me know if I can help you further.

  3. Pete Clement says:

    We are having a terrible time getting Part B started. I worked past 65, am 69 now, and just retired in September. Through the years since 65 I have had 2 employers. I have saved the Certificates of Creditable Coverage, which I received each year since 65. However, I learn now that these are not sufficient and we must submit L564 from each employer. I also learned, after first submitting copies of these forms for my wife and myself, that Medicare absolutely requires the original, pen and ink signed copies of the forms. Electronic and photocopies are not acceptable to them. In 45 days of trying, I have been unable to get these originals from either employer.
    Do you know of any alternative to this requirement? We are running out of time to file for Medicare.

    This has been so frustrating for me that at this point I just want to get this form for my wife, so that she can get hers started. With that, she can then get going on a supplement, and other details. I do not believe I will, and do not care if, I get my own Medicare anymore, or not, since it has been such a hassle.

    Any suggestions you can offer?

  4. Denise says:

    I’m sorry to say that I don’t know how you resolve your problem with Social Security and signing up for Medicare Part B. 

    Were you in the Social Security office?  Did you ask to speak to a supervisor?

    I think that anyone from your past employers can sign the form – as long as they are willing to talk to Social Security if they get a call to confirm the information.

    As a last resort, you should contact your Congressman’s office as he/she should have someone on staff who deals with issues related to Medicare and Social Security.  You have to email the office with your request for help.  Then they will have someone contact you from the local office.  I don’t know if they can help, but I do know that when a Congressman’s office calls a government office (like Social Security) they get some attention.

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