Need Help with Medicare Issues? Contact Your Local Congressperson!

Toni,

I read last week’s Medicare Part D question from Tonya, in which she discovered that she and her husband are receiving an “extra” Part D premium she never knew about. You advised her to contact her local Congressional office to help appeal the Medicare issue. 

I now must fight Social Security because they are under the impression that I have waited past my 8-month window to enroll in Medicare, which I did not. I did turn in my forms to the local Social Security office within the correct window, but that local office has lost my paperwork and will not accept what I have because they say it is past the enrollment window.  I am now receiving a Part B penalty.  What a nightmare!

Can you please explain what one should do to get help from your Congressperson in appealing an inaccurate decision about Medicare from a local Social Security agent?

Evelyn from Conroe, TX

Hello Evelyn,

If you need help rectifying your Social Security and Medicare issues, talk with your area’s congressional office. Because Medicare and Social Security are federal programs, your congressional office will help you solve your problems. Visit your congressperson’s website for the local office contact information. Alternatively, you can email your congressperson from the website.   

Page 19 of the 2025 Medicare & You Handbook under “Should I get Part B?” discusses the rules of leaving employer’s benefits when you are “still working” past 65.

How to Enroll in Medicare Part B when You’re Past 65 and Leaving Employer Benefits

1. Download the forms CMS-L564 (Request for Employment Information) and CMS-40 B (Application for Enrollment in Medicare-Part B) from SSA.gov.
2. Have your human resources department sign off on the CMS-L564 (Request for Employment Information) form and attach it to CMS-40B.
3. Under item #9 (Remarks) on the CMS-40B, write what month Part B should begin.
4. File both forms with the local Social Security office. Advise the SS representative that you’re losing your company benefits and need your Medicare Part B to begin the day after your last day of employment.
5. Make copies of every document given and received from the SS office.

How to Enroll in Medicare When You’re Turning 65 and NOT Receiving Your Social Security Check

Go online to www.ssa.gov/medicare/sign-up at least 90 days before turning 65 and apply online. It’s truly that easy!

More on Medicare Enrollment

During a Toni Says Medicare consultation, the Medicare team informs those retiring past 65 that the Special Enrollment Period (SEP) begins the month they lose employer benefits or employment ends.  Many enroll in Part B with a big surprise finding they are penalized 10% each year or 12-month period, they could have had Part B but didn’t. The penalty goes back to the day they turned 65 or the day their Part A began.

Below are a few of the Social Security forms used for Medicare.

• CMS-L564-Request for Employer Benefits: This form shows proof of employer health benefits from the specific employer.  If you have had 2 or more employers since turning 65, have a CMS-L564 form signed by each employer to turn into Social Security when applying for Medicare Part B.
• CMS-40B-Application for Enrollment in Medicare Part B: This form is the application for enrolling in Medicare Part B (medical insurance) Attach this form with the CMS-L564- (Request for Employer Benefits) when applying for Part B after leaving employer benefits past 65 and 90 days.
• SSA-44-Medicare Income-Related Monthly Adjusted Amount – Life-Changing Event: Form advises Social Security of a major life-changing event, and your income has lowered.  Life-changed events can be married, divorced, death of a spouse, stopped working or reduced hours, lost, lost property, pension plan stopped, and more options on the SSA-44 form.
• CMS-1763: Request for Termination of Premium Medicare Part A (hospital) or Part B (medical). Form for stopping Medicare Parts A and B when needed. (Does not need SEP written at the top of the form.)

Note: Don’t forget to write on the top of specific forms CMS-L546, CMS-40-B, and SSA-44, “Special Enrollment Period” when turning the forms into the local Social Security office in your area or emailing your forms to the email address which the Social Security representative has given you.

Evelyn, you should put together any documents and evidence to prove you did not wait past your 8-month window to apply for Medicare after leaving employer benefits.  Have them ready to show or send to a representative from your congressperson’s office. Remember, your local congressperson is there to help. Don’t be afraid to reach out!

More Medicare Resources

• Contact Toni Says Medicare: Call (832) 519-8664 or email [email protected].
• Get Toni’s Book: The Medicare Survival Guide, Advanced Edition

Medicare decisions can be overwhelming, but resources are available to help:

• Visit Medicare.gov: Explore tools and information to compare plans.
• Seek Expert Guidance: Reach out to trusted advisors who specialize in Medicare to customize a plan for your needs.
• Engage Family Support: If navigating Medicare feels overwhelming, involve trusted family members to assist with decisions and research.

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