CMS Form 40B and CMS Form L564

Medicare Part B Enrollment after Retiring from work age 66-75


Let’s say you’re past the age of 65.  You have your Medicare part A and you’re still working.  Now you’re maybe 70 years 

old and you say to yourself, “ I want to retire.  I want to get on Part B and start Medicare as my health 

insurance.  I’ve been getting health insurance from my employer or my spouse has been getting health 

The first step that you’re going to want to do is go to Now you’re going to want to do 

this at least four months prior to when you’re going to retire. The reason is you can go on Medicare Part

any month of the year if you’ve had health insurance from the time you were 65 years old when you were 

eligible for Medicare up until now when you’re about to retire.  

If there was a break in your coverage you’re going to have to sign up between January 1st and 

March 31st.  Your coverage is going to still start July 1st but let’s just say you’ve worked for the same 

person for the past 30 years.   You wanted to work until you’re 70 or 68 whatever it is, so you did not get 

on Part B.

 In this video I’m going to show you how to get on Part B and start your Medicare.  The first thing 

you want to do is- go to  As you see up here in the URL.  Now when you get here you’re going to 

have to print out two forms.  The first form, and I actually did a video on this I think it was a couple years 

ago,  I want to put it on the screen here because the video is great but I didn’t put it on this channel and it’s 


CMS Form 40b and CMS Form L564

to do is the 40b and it’s a little bit different but I’ll go over this.  So you type in 40b in this search engine on, click the search and it’s the very first link up here.   You’ll click on that link and then you’ll scroll 

down a little bit where it says downloads and you can go to related links also.  Right here downloads-  40b 

English.  You’ll click on that and this will take you to the PDF that you need to fill out.  Now you can fill this 

out actually online you know which will make it nice and clean or you can just print it and fill it out hand 


 Now if it’s just you who’s going on Medicare fine, you need one form for this and one form for the 

number.  You and your spouse if you’re both past 65 you’ll have a Medicare number because you’ll have 

Medicare part A but you’ll want to get on Part B so you’ll sign this, date it and hold on to it.  The next form 

is a little bit more complicated so when you go to let’s see here CMS here when you go to gov 

you’ll put in form L five six four.  You’ll search that and just like the other one the first one here you’ll click 

on and this has two forms to download.   

Basically I just go to this one right here, the related links, click on that and if you scroll down it will 

have a downloadable form.  It’ll look like this and then down here, as you see, it says download and print 

to PDF.   So you can actually do the same thing.  You can type in your information here and then you can 

download it to print it if you like or you can just print it and then hand write it in here.   The thing about 

this l564 you’ll print this twice but the person who’s working and getting the benefits the first one they’ll fill 

out as the applicant and the employee.  So their name will go on number four and on line six and it will 

also go.  The social security number will be the same on line five and line seven here because they’re 

filling it out for themselves and then the biggest thing is this start date.  Number two of course number 

one is going to be yes your employer Group Health if that’s what you were and then the date the

applicant’s coverage began.  This is going to have to be before  you were eligible for Medicare. 

 Let’s say you changed jobs three times.  You’re gonna have to go get this form filled out three 

different times by three different employers.  This is why I say this process could take months and even 

when you get this done you’re going to fax it into a certain number I’ll put on the screen at the end but 

you’ll want to start this a lot earlier than if you were just going on Medicare when you turn 65.  So you’ll fill 

out this form.  You’ll have your employer down here sign it and date it and then you’ll print it off.  The one 

thing that I forgot to mention is you’ll have to print off a second one because it will be for the applicant 

which would be your spouse and then the employee which would be you.  They would fill out their 

applicant name, their social security number here and then you the employee would fill out your name and 

your Social Security.  

One would have the same applicant name and employee name the other would have the 

spouse as the applicant name and then the employee as the employee name with the different Social 

Security numbers.   You already have it printed but you’ll have your employer sign this and then you’ll fax it 

to a certain number. Now I’m going to put that number on the screen.  Here is the fax number that you’ll 

fax it into this is the national fax number.  This is very important.  Like I said, you’ll want to do this as early 

as possible if  you have broken coverage.  You have to do this between January and March 31st.  Your 

coverage will start in July if you did not have broken coverage.  You’ll get this filled out by every employer 

 The Medicare enrollment fax number is 1-833-914-2016.  

Your next step after you sign up is to see if you want a Medicare supplement plan or an advantage plan from AARP or Aetna.   Some people also choose Wellcare or Silverscript for the prescription part d drug plan.  

Disclaimer: This video and blog post are for entertainment purposes only.  If you want advice on Medicare or any of its plans, please speak to a licensed agent, whether it is me or another licensed agent. No advice should be taken from this video or blog post.  If you don’t speak to me about your individual concerns, I can’t give you my 100% opinion. Brian Monahan and Medicare 365 are not responsible for any actions that you take without consulting with a licensed insurance agent.