Changes to Medicare Online Enrollment After Age 65

Prior to the COVID-19 pandemic, those who retired after age 65 and decided not to enroll in Medicare Part B, had two options to enroll:

1. Go to their local Social Security office, (which was often the most expedient) or;
2. Call Medicare

With the new social distancing measures in place, Social Security offices are closed down or left with limited hours, leaving potential beneficiaries with only the option to call. Beneficiaries can call 1-800-772-1213, say the word “Medicare”, and then wait for assistance. The issue is that the wait time is often extreme and frustrating for some. Fortunately, SSA/CMS has implemented an online enrollment tool for those Beneficiaries enrolling after age 65.

Changes to Medicare Online Enrollment’s New Tool Implementation

The new online enrollment tool has essentially taken the Medicare Part B enrollment form, and the Request for Employment Information form, and created an online application that the beneficiary can submit on their own. The applicant can complete the new online form, then upload proof of coverage and employment, (such as an ID Card and Paystub.)  They will need to e-Sign to finalize the enrollment, but the employer will not need to sign.

Full details are below:

SSA has a new online service option that beneficiaries can utilize to complete the forms CMS-40B, Application for Enrollment in Medicare – Part B (Medical Insurance) and CMS-L564, Request for Employment Information applications for enrollment in Medicare Part B. The online process will expedite the handling of those beneficiaries requesting enrollment in Medicare Part B under the Special Enrollment Period (SEP) provisions.
Effective Tuesday, May 26, 2020, based on the collaborative efforts between the Centers for Medicare & Medicaid Services (CMS) and SSA, the new online process for handling Medicare Part B SEP enrollment will be available online. The online process provides beneficiaries the option to complete the Medicare enrollment forms under a SEP for SSA to process. The online Medicare Part B SEP enrollment.
Medicare Part B SEP will be available on both SSA and CMS websites effective Tuesday, May 26, 2020. Once the beneficiary completes the online enrollment forms, the forms will automatically be transmitted to the SSA Field Office of jurisdiction.

Eligibility Overview

As a requirement, regardless of the service channel, in order to enroll for Medicare Part B during a SEP, the following are required:

• The individual must be covered under a group health plan (GHP) based on his or her own or a spouse’s current employment status, or covered under a large group health plan (LGHP), and the coverage must be based on his or her own, or a family member’s current employment status.
• The individual can enroll:
  • During any month (including a partial month) in which they are enrolled in a GHP or an LGHP based on current employment status, or
  • In any of the 8 consecutive months following the last month, during any part of which, the individual was enrolled in the GHP based on current employment status,
  • Or beneficiaries are eligible for equitable relief if:
    • The beneficiary had a SEP during the period from March 17, 2020, through June 17, 2020; and
    • The beneficiary did not apply for Part B during that SEP.
    • Eligible beneficiaries who wish to take advantage of the equitable relief must file their enrollment request by June 17, 2020.
• The beneficiary must complete the CMS-40B enrollment form, paper, or online to request enrollment. In addition, he or she must complete the CMS-L564 form, paper, or online.
• Form CMS-L564 has two sections:
  • Section A – the applicant completes Section A.
  • Section B – the employer, the GHP or LGHP completes Section B of the form. The information in Section B provides evidence of GHP or LGHP coverage and dates of employment.

NOTE: If the employer cannot sign the CMS-L564, the beneficiary can provide other evidence of previous employment or coverage of GHP or LGHP, or other documents for evidence of employment. Refer to HI 00805.295 – Evidence of GHP or LGHP Coverage Based on Current Employment Status.

Online Enrollment Guidelines

• The online enrollment process will require beneficiaries to complete the CMS-40B, CMS-L564 (one combined online application), and submit any required evidence during one online session.
  NOTE: The online enrollment process does not offer beneficiaries the option to save and revisit the application.
• Failure to complete and submit the correct documentation may result in a delay in processing the Medicare enrollment.
• If the beneficiary fails to complete the forms or submit the correct evidence, Field Offices should follow the normal business processes and develop for the missing information.

During the COVID-19 pandemic, CMS waived the wet-signature requirement; however, the online option will require beneficiaries to provide an eSignature (digital signature) and a valid email address.