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  • Cms-l564 S 2016

Get Cms-l564 S 2016-2025

FORMULARIO? ¿QUÉ HAGO CON EL FORMULARIO? Para solicitar Medicare en un Período de Inscripción Especial, debe tener o haber tenido cobertura del plan de salud grupal en los últimos 8 meses a través de su empleo actual o el de su cónyuge. Las personas con discapacidad deben tener la cobertura del plan de salud grupal grande sobre la base de su empleo actual o el de su cónyuge o de un miembro de la familia. Llene la Sección A y lleve el formulario a su empleador. Pídale a su empleador .

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Go to Apply Online for Medicare Part B During a Special Enrollment Period and complete CMS-40B and CMS-L564. ... Fax your forms to 1-833-914-2016. Mail your CMS-40B, CMS-L564, and evidence to your local Social Security field office.

You need to get the completed form from your employer and include it with your Application for Enrollment in Medicare (CMS-40B). Then you send both together to your local Social Security office. Find your local office here: www.ssa.gov.

Form CMS-L564 has two sections, A and B. You will fill out section A and the employer will fill out section B. You'll need to provide the name and address of your or your spouse's employer's. Then, you'll list your name and your Social Security Number (SSN).

You need to get the completed form from your employer and include it with your Application for Enrollment in Medicare (CMS-40B). Then you send both together to your local Social Security office. Find your local office here: www.ssa.gov.

When you're first eligible for Medicare, you have a 7-month Initial Enrollment Period to sign up for Part A and/or Part B. If you're eligible for Medicare when you turn 65, you can sign up during the 7-month period that: Begins 3 months before the month you turn 65. Includes the month you turn 65.

Form CMS-L564 has two sections, A and B. You will fill out section A and the employer will fill out section B. You'll need to provide the name and address of your or your spouse's employer's. Then, you'll list your name and your Social Security Number (SSN).

Letter or statement from Medicare or the Social Security Administration stating your Medicare Part A coverage termination date. Document from a government agency showing you or your family members are:

If you are already enrolled in Medicare Part A and you want to enroll in Part B, please complete form CMS-40B, Application for Enrollment in Medicare Part B (medical insurance).

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© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232
Form Packages
Adoption
Bankruptcy
Contractors
Divorce
Home Sales
Employment
Identity Theft
Incorporation
Landlord Tenant
Living Trust
Name Change
Personal Planning
Small Business
Wills & Estates
Packages A-Z
Form Categories
Affidavits
Bankruptcy
Bill of Sale
Corporate - LLC
Divorce
Employment
Identity Theft
Internet Technology
Landlord Tenant
Living Wills
Name Change
Power of Attorney
Real Estate
Small Estates
Wills
All Forms
Forms A-Z
Form Library
Customer Service
Terms of Service
DMCA Policy
About Us
Blog
Affiliates
Contact Us
Privacy Notice
Delete My Account
Site Map
All Forms
Search all Forms
Industries
Forms in Spanish
Localized Forms
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
airSlate workflows
DocHub
Instapage
Social Media
Call us now toll free:
1-877-389-0141
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232