COVID-19 Pandemic Highlights Need for Changes in Medicare Enrollment Process

UPDATE 4/10/20: The Social Security Administration (SSA) has notified us and the public that it is working with the Centers for Medicare and Medicaid Services (CMS) to provide relief from certain enrollment requirements, and is already waiving the requirement to have an employer complete a section of form CMS-L564 as part of the Part B application (see below for details on the application process). SSA advises that it can take up to 21 days to process one’s application. If you are applying for Medicare Part B due to a recent loss in employment or group health coverage, your medical coverage will be effective the month following the date SSA receives your request to enroll. Here are links for online applications for Medicare Part A and the Low-Income Subsidy, and here’s a PDF file for applying for Medicare Part B, which must be mailed in to your local Social Security office.


We’ve been hearing of some Medicare enrollment challenges for older adults who delayed their Medicare enrollment due to work. Now, with the spread of the coronavirus (COVID-19), many of these older adults are stopping work and having a hard time enrolling in Medicare due to pandemic-related obstacles. Many of these people cannot work as they are expected to stay home, don’t want to work because fear of contracting the virus, or have lost their jobs and their employer’s health insurance.


While the Centers for Medicare and Medicaid Services (CMS) has specific steps for seniors in these situations to enroll in Medicare Part B, not all of them are possible to do with the shutting down of offices to slow the virus’ spread. For example, to enroll in Medicare Part B after ending one’s employment, two forms must be filled out. One is form CMS 40B, Application for Enrollment in Medicare – Part B; the other one is CMS L564, Request for Employment Information. This latter one must be filled out by the person’s employee to verify that yes, they had health insurance while working with their employer. Yet with many companies closed, or employers working from home, they have no access to these people’s records.


In addition, even if an older adult can get their form filled out, they would normally take it to their local Social Security Office to get it processed quickly. While it can be mailed in, that just takes more time. Now, however, all the Social Security offices are closed due to COVID-19, which will slow down this enrollment process and access to coverage.


California Health Advocates is contacting CMS and working with other advocates to remedy this situation and help seniors be able to enroll into Medicare Part B more quickly. Currently, people who are newly eligible for Medicare can easily and quickly sign up online. One solution would be to allow all seniors to do this, especially during this pandemic. Social Security could also go ahead and enroll people into Medicare Part B, even if they don’t yet have Form CMS L564. As that form is used to determine if the person is subject to a Part B late enrollment penalty, those could always be applied retroactively.


Another option seniors can do now is to send in the Form CMS L564 and write that they have done their due diligence and cannot reach their employer due to COVID. They can state that they need Medicare ASAP, request to be enrolled immediately and ask Social Security to contact their employer at a later date. In addition, there is a Social Security POMS provision that states if an employer is not available to fill out the FORM CMSL564, the former employee can send in other documentation instead, such as tax returns, statements of health insurance paid by the employer, etc. (See POMS HI00805.295A)


In addition, some Social Security offices are making telephone appointments and will honor the date of the phone call as the “date of application”.


This is a serious situation and requires a policy remedy. In the worst cases, people could have a stretch of time with no health insurance coverage. That could be catastrophic during the spread of coronavirus. If you or someone you know is in this situation, contact your local Health Insurance Counseling and Advocacy Program (HICAP) for assistance. We will keep you updated on policy-based solutions as well.

Karen Joy Fletcher

Our blogger Karen Joy Fletcher is CHA’s Communications Director. With a Masters in Public Health from UC Berkeley, she is the online “public face” of the organization, provides technical expertise, writing and research on Medicare and other health care issues. She is responsible for digital content creation, management of CHA’s editorial calendar, and managing all aspects of CHA’s social media presence. She loves being a “communicator” and enjoys networking and collaborating with the passionate people and agencies in the health advocacy field. See her current articles.