Ask Larry

My domestic partner "Linda" (we are not married) is preparing to file for SEP Medicare Part B (Linda is moving to another state outside the coverage of her current health insurance plan). Linda is 66 and disabled, and at age 61 was auto-enrolled in Medicare (when she qualified for disability), and she eventually got the Part-A only Medicare card after proving health care coverage through my employment. She will have the Request for Employment Information Form 0938-0787 from my employer showing continuous coverage since 2009. The coverage is still in effect but will end when Linda makes the out-of-state move. My company has over 3000 employees. Questions: (1) When Linda visits the local social security field office to formally file for Medicare Part B, since I am a "family member" and not formally a "spouse" what documentation (if any) will be required to "prove" my company has >100 employees. How does (or do they even check?) the ss office verify this? (2) Given the scenario described, do you see any reason Linda would not qualify for a SEP? Thank you for your help! David

Hi David,

Social Security uses form CMS-L564 (https://www.cms.gov/Medicare/CMS-Forms/CMS-Forms/Downloads/CMS-L564E.pdf) to verify coverage under an employer group health plan (EGHP) for special enrollment period (SEP) purposes.

My understanding of the SEP regulations is that a person must be covered under their own or a spouse's EGHP in order to qualify for an SEP after age 65. So, yes, unfortunately I do think there may be a problem with Linda's SEP eligibility. I don't claim to be an expert on Medicare, however, so I'm not certain that I am correct. For more information, refer to Medicare's website:

My domestic partner "Linda" (we are not married) is preparing to file for SEP Medicare Part B (Linda is moving to another state outside the coverage of her current health insurance plan). Linda is 66 and disabled, and at age 61 was auto-enrolled in Medicare (when she qualified for disability), and she eventually got the Part-A only Medicare card after proving health care coverage through my employment. She will have the Request for Employment Information Form 0938-0787 from my employer showing continuous coverage since 2009. The coverage is still in effect but will end when Linda makes the out-of-state move. My company has over 3000 employees. Questions: (1) When Linda visits the local social security field office to formally file for Medicare Part B, since I am a "family member" and not formally a "spouse" what documentation (if any) will be required to "prove" my company has >100 employees. How does (or do they even check?) the ss office verify this? (2) Given the scenario described, do you see any reason Linda would not qualify for a SEP? Thank you for your help! David

Hi David,

Social Security uses form CMS-L564 (https://www.cms.gov/Medicare/CMS-Forms/CMS-Forms/Downloads/CMS-L564E.pdf) to verify coverage under an employer group health plan (EGHP) for special enrollment period (SEP) purposes.

My understanding of the SEP regulations is that a person must be covered under their own or a spouse's EGHP in order to qualify for an SEP after age 65. So, yes, I think that there may be a problem with Linda's eligibility for an SEP. I don't claim to be an expert on Medicare, however, so I'm not certain that I am correct. For more information on this subject, refer to Medicare's website: https://www.medicare.gov/supplement-other-insurance/how-medicare-works-with-other-insurance/who-pays-first/which-insurance-pays.html#collapse-2453.

Best, Jerry