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Will My Domestic Partner Qualify For An SEP Based On Coverage Under My Employer's Plan?

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-w....

Best, Jerry

Category: 
Posted: 
May 12 2017 - 12:55pm
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