If you are older than 65 and are leaving, or recently left your employer plan, you will need to show Medicare that you had prior, qualifying coverage.
This is so that Medicare does not charge you a penalty for not having signed up with Medicare when you were first eligible, turning 65 years of age.
If you opted for COBRA (continuation of employer insurance), you MUST still apply for Medicare no later than the 8th month on COBRA, even if you are planning to continue on COBRA beyond the 9th month. This is to avoid the Medicare penalty and having lost this enrollment window.
Now, here’s how to get started when coming from an Employer/Group plan:
IF YOU CAN TAKE A PHOTOGRAPH OR SCAN IN YOUR VERIFICATION OF GROUP HEALTH PLAN COVERAGE (THAT YOU HAVE HAD WITHIN THE LAST 8 MONTHS), YOU CAN NOW USE THIS ELECTRONIC FORM AND SKIP THE PAPERWORK OPTION BELOW.
HERE IS THE ELECTRONIC WAY TO APPLY NOW, IF YOU CAN SCAN OR PHOTOGRAPH THE PROOF OF PRIOR COVERAGE – CLICK HERE.
If you do NOT have the ability to photograph or scan documents and use the electronic version, here is your path:
Download both forms below
(“Part B Enrollment” and “Part B Employer Verification of Benefits Form”).
Fill out “Part B Enrollment” and be sure to legibly write the date you’d like Part B to begin on the form
Have HR (Former employer) fill out “Part B Employer Verification of Benefits Form”.
If the employer cannot fill out the Employer form for you, you can fill out Section B yourself. You would then need to submit one of the following forms as secondary evidence:
income tax form that shows health insurance premiums paid;
W-2s reflecting pre-tax medical contributions;
pay stubs that reflect health insurance premium deductions;
health insurance cards with a policy effective date;
explanations of benefits paid by the GHP or LGHP; or
statements or receipts that reflect payment of health insurance premiums.
Overnight these two forms to your local SSA office or send via certified mail with “URGENT” written on the envelope.
Here is a directory of the Social Security offices:
You could also fax the forms to:
1-833-914-2016 or, now, upload them on the Social Security website if you have a scanner.
Contact us below!