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How to Apply for Medicare Part B (Medical Insurance) During Your Special Enrollment Period
SSA.gov
How to Apply for Medicare Part B
(Medical Insurance) During Your Special
Enrollment Period
At age 65, most people in the United States should enroll in
Original Medicare (Part A and Part B). However, since Part
B has a monthly premium that must be paid, some people
sign up for Part A only. They don’t enroll in Part B at age 65,
because they:
• Are still working and are covered by an employer’s
group health plan.
• Have a spouse who’s working and has medical
coverage under their spouse’s employer’s group
health plan.
Also, some individuals want to continue making
contributions to a Health Savings Account (HSA).
However, if they enroll in Medicare, Social Security, or
Railroad Retirement Board (RRB) benets, they may
incur a tax penalty from the Internal Revenue Service
(IRS). In either case, a Special Enrollment Period (SEP)
may be available when it becomes necessary for them to
start their Medicare coverage.
The SEP allows most beneciaries who meet the
conditions outlined above to enroll in Medicare without
having to wait for the General Enrollment Period (GEP).
This allows them to avoid having a gap in medical
coverage and paying a penalty for late enrollment. There
are limitations, so we strongly advise you to contact the
Centers for Medicare & Medicaid Services (CMS) for
more information. The contact information for CMS is on
the next page of this fact sheet.
NOTE: Ask your personnel ofce if you have group
health plan coverage. People with group health
coverage based on current employment may be able
to delay Part A and Part B. They won’t have to pay a
lifetime late enrollment penalty if they enroll later.
If your employer has fewer than 20 employees, Medicare
generally pays rst.
When can I enroll in my SEP?
You can use an SEP to enroll in Medicare Part B while
you’re still in a group health plan based on current
employment. Also, if your employment ends or employer-
provided medical coverage ends, you have eight months
from that month (whichever comes rst) to sign up for
Medicare Part B. This will prevent a delay in coverage
and possible penalty.
NOTE: The following don’t count as coverage based
on current employment: Consolidated Omnibus Budget
Reconciliation Act (COBRA) coverage, retiree health
coverage, Veterans Affairs (VA) coverage, or individual
health coverage (like through the Health Insurance
Marketplace).
You cannot enroll in Medicare using a SEP during
your Initial Enrollment Period (IEP). Your IEP starts
three months before the month you reach age 65 and
ends three months after the month you turn 65. If you
want to know more about enrollment periods, go online
and read Medicare (Publication No. 05-10043) at
www.ssa.gov/pubs/EN-05-10043.pdf or talk to your
personnel ofce.
When will my Part B coverage start?
You may sign up while you’re still in a group health plan
or during the rst full month when you’re no longer in the
plan. Also, you may sign up when the covered employee
stops working (whichever happens rst). If so, your
coverage will begin at either time below:
• On the rst day of the month you enroll.
• On the rst day of any of the following three months of
your choice.
If you enroll during any of the remaining seven months of
the SEP, your coverage will begin on the rst day of the
following month.
NOTE: Premium-free Part A coverage begins six
months before the date you apply for Medicare (or
Social Security or RRB benets). It can begin no earlier
than the rst month you were eligible for Medicare.
You can’t contribute to your HSA once your Medicare
coverage begins. To avoid a tax penalty, you should
stop contributing to your HSA at least six months before
you apply for Medicare.
NOTE: Some beneciaries with higher incomes will pay
a higher monthly Part B premium. For more information
about the premium amount higher income individuals
pay, visit our webpage Medicare Premiums: Rules for
Higher Income Beneciaries at www.ssa.gov/benets/
medicare/medicare-premiums.html.
Social Security Administration
Publication No. 05-10012
September 2022 (Recycle prior editions)
How to Apply for Medicare Part B (Medical Insurance) During Your Special Enrollment Period
Produced and published at U.S. taxpayer expense
What happens if I don’t sign up for
Medicare Part B?
If you don’t sign up for Part B when you’re rst eligible
and you don’t qualify for a SEP:
• You may have to pay a late enrollment penalty for as
long as you have Part B.
• You may have to pay all of the costs for doctors’
services, outpatient care, medical supplies, and
preventive services.
• You can only sign up between January 1 and March
31, which may delay and cause a gap in health care
coverage. Your coverage starts the rst day of the
month after you sign up.
How to apply
You may not have signed up for Medicare at age 65,
perhaps because you have health coverage through
an employer or a Health Savings Account. If so, you
can apply on our website using our online Medicare
application at www.ssa.gov/benets/medicare/.
If you already have Medicare Part A and you want to
enroll in Part B, you can use one of the following options:
1. Go to “Apply Online for Medicare Part B During a
Special Enrollment Period” and complete CMS-40B
and CMS-L564. Then, upload your evidence of Group
Health Plan (GHP) or Large Group Health Plan
(LGHP) coverage based on current employment. You
can complete and upload Form CMS-L564 (Request
for Employment Information), or provide written
notication (a letter, fax, or email) from the employer,
GHP, or LGHP.
2. Fax your CMS-40B and employer-signed CMS-L564
(or written notication) to your local Social Security
ofce.
3. Mail your CMS-40B and employer-signed CMS-L564
(or written notication) to your local Social Security
ofce.
NOTE: When completing the CMS-L564:
• State, “I want Part B coverage to begin (MM/YY)” in
the remarks section of the CMS-40B form or online
application.
• If your employer is unable to complete Section B of
the CMS-L564, please complete that portion as best
as you can on their behalf and submit one of the
following forms of secondary evidence:
— Income tax returns that show health insurance
premiums paid.
— W-2s reecting pre-tax medical contributions.
— Pay stubs that reect health insurance premium
deductions.
— Health insurance cards with a policy effective date.
— Explanations of benets paid by the GHP or LGHP.
— Statements or receipts that reect payment of
health insurance premiums.
It is easy to complete and submit your application online.
You can also submit the completed and signed forms
CMS-40B and CMS-L564 (or written notications) by
mail or by contacting your local Social Security ofce.
After your application is processed, you’ll receive a
Medicare & You Handbook (Publication No. CMS-10050)
that describes your Medicare benets and plan choices.
For the latest information about Medicare, please
visit Medicare.gov or call the toll-free number
1-800-MEDICARE (1-800-633-4227) or TTY number,
1-877-486-2048, if you’re deaf or hard of hearing.
Contacting Us
The most convenient way to do business with us is to
visit www.ssa.gov to get information and use our online
services. There are several things you can do online:
apply for benets; start or complete your request for
an original or replacement Social Security card; get
useful information; nd publications; and get answers to
frequently asked questions.
Or, you can call us toll-free at 1-800-772-1213 or
at 1-800-325-0778 (TTY) if you’re deaf or hard of
hearing. We can answer your call from 8 a.m. to 7 p.m.,
weekdays. We provide free interpreter services upon
request. For quicker access to a representative, try
calling early in the day (between 8 a.m. and 10 a.m. local
time) or later in the day. We are less busy later in the
week (Wednesday to Friday) and later in the month.
You can also use our automated services via telephone,
24 hours a day, so you do not need to speak with a
representative.
