How to avoid the #1 Mistake on Medicare’s Request for Employment Verification Form

How to avoid the #1 Mistake on

Medicare’s Request for Employment Verification Form

How many of you dread filling out Medicare forms?  Please raise your hand if you’ve ever had to correct the Medicare “Request for Employment Information” form (CMS-L564) for your employee.  When you complete the form, you’re hit with a fear that you might not remember how to properly complete this form.  Sure, you might fill them out from time to time, but this form never seems clear.  It’s daunting enough to prepare your employees for retirement – never mind assisting them with the Medicare process which seems like a full-time job itself.


Well, there is good news!  There is really only 1 question on this form that seems to trip people up.  AND we’re here to help you understand what Medicare is asking on this question and hopefully help you and your employees avoid any future issues.


Take a look at Section B of the “Request for Employment Information” form below.  Section B is the employer’s (aka HR Department’s) section.  And Question #2 is normally the main problem.  Are you ready to conquer this question?  Let’s dive in.








As most of you know, this “Request for Employment Information” form is required if your employee is over the age of 65 and outside of their initial enrollment period for Medicare.  They must submit this form with their Medicare Part B enrollment form to qualify for a Special Enrollment Period to sign up for their Medicare upon retirement.


For your employee to qualify for a SEP, they must meet 2 criteria:

  1. They must have group health insurance from ACTIVE employment (from their job or their spouse’s job) or have had such insurance within the past 8 months. AND
  2. They must have been CONTINUOUSLY covered by a job-based insurance since becoming eligible for Medicare (including the month they turned 65.)


For the most part, this form is filled out properly with no concerns.  But question #2 is typically the exception.  AND if question #2 is incorrect, it could mean big headaches for your employee.


So, why is Question #2 such an issue?  Well, if question #2 doesn’t reflect that the employee had insurance back to the month they turned 65 they WILL NOT qualify for a Special Enrollment Period.  No SEP could = BIG PROBLEMS for your employee.  It could delay their Part B start date and your employee could be assessed a Part B late enrollment penalty that will follow them for the rest of their life.


Question #2 states “If yes (the applicant was covered under employer group health plan), give the date the applicant’s coverage began. (mm/yyyy)


It seems simple enough.  You might wonder why that is so hard to answer?  Well, time and again we see that this date doesn’t reflect how long the employee had coverage but when the last “new” insurance company started.  For example, John Doe is 70 and has worked for your company for the last 20 years.  He has had group health coverage since February 1999.  BUT your company switched to a new insurance company on January 1, 2018.  Many times, we see the January 1, 2018 date on this form.


If the January 1, 2018 date is used, John Doe doesn’t qualify for a SEP because it doesn’t show that he’s had group health insurance from age 65 on.  John Doe will have to wait to sign up for Medicare Part B during the general election period (Jan 1 through March 31 each year).  His Part B coverage wouldn’t start until July 1.  John Doe would also have to pay a Part B late enrollment penalty for the months that he didn’t have coverage since turning 65.  This late enrollment penalty would last for the rest of his life. 


But, if the correct date is used in Question #2: February 1, 1999, he should qualify for a Special Enrollment Period.  He could elect the Part B start date (1st of the month).  He should not be assessed a Part B late enrollment penalty.  All is good (at least with the Medicare insurance.)


Now that you know how to tackle the Medicare “Request for Employment Information” form, you’re ready to focus on the many other aspects of your employee’s retirement process.  Do you have more Medicare questions?  Give Seniormark LLC a call at 937-492-8800.  We’re here to help!


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