Skip to main content

How Human Resources Should Handle Medicare’s Request for Employment Verification Form: Avoiding Common Mistakes 

Written By Don Balascak, MBA


Human Resources professionals often receive requests from employees for proof of group health coverage for their Medicare enrollment application.  Form CMS L564 – “Request for Employment Information” is the form Medicare uses to gather this information.   This form has sections that must be completed by the employer, and it is required to process a Medicare enrollment application when the employee continues to work past 65 and has maintained group coverage.  We see a lot of confusion between the employees and Human Resources about who completes which section of the form, or if they complete it at all. Per Medicare requirements, this form must be completed by both the employee and Human Resources.

We also see many forms getting rejected by Medicare because they are filled out incorrectly or incompletely. To help you and your employees avoid redoing this form due to common errors, here is a breakdown to help you both fill it out correctly:

Section A:

The employee will complete Section A of the form which provides the employer with the relevant information to research the details on the employee’s employment and coverage.

Section B:

The Employer then completes Section B, which covers the rest of the form. Most of it is self-explanatory, but there are a few areas that are often filled out incorrectly by the HR or Benefits team:

  • Section B Question 1 – the answer should always be YES.

  • Section B Question 2 - asks for the date that the applicant’s coverage began. Many fill out the form thinking that it is referring to the current year’s benefits period, but it is not.  Instead, you need to list the date that the employee originally began coverage in the employer’s group plan – often going back to when they started with the company. If answered with the wrong date, it can set the employee up for significant complications including lifetime penalties for not having “creditable coverage”.  If documents are hard to find, make sure to complete this form showing coverage from at least the beginning of the year the employee turned 65.

  • Section B question 5 - asks the employer to indicate when the employee worked for the company. We see numerous areas of confusion in this question. It is critical that the employer lists the start and end date, or “still employed” dates of employment for the employee.  Some employers incorrectly choose the current benefit year as the start of employment date, so be sure you put the actual hire date. Secondly, if the employee is still employed the day the form is being completed – then you should list the month and year of the date of application.

  • Important note: This is key – “Current Employment” does not apply to retirement, severance or disability pay.  Current employment means that the employee is actively working for the company.

  • Signature of Company Official, title, and date. This section can get missed because it is located on the very bottom of the form.  It is a crucial attestation that needs to be completed by Human Resources or the form will be incomplete for the employee.  If it is submitted without this, there will be unnecessary complications to the application process – including penalties if dates are missed.

If you are unsure about Medicare enrollment for your employees, ask us!  We help Human Resources answer complicated questions. Don Balascak, MBA is a founding member of The Medicare Navigators.  Medicare is complicated and our mission is to help HR representatives and Medicare eligible employees with personalized assistance at no cost.

You can download the Form CMS L564 – “Request for Employment Information” with full instructions in both English and Spanish below.

Download CMS L564 - English
Download CMS L564 - Spanish