ArcaMax

Dear Toni:

I need your assistance to enroll in Medicare because I am past 65 and still working full-time with employer benefits. Sherry, the office manager from my cancer doctor’s office, said that my employer’s health plan denied the recent claim for my cancer treatment. The health plan considers it to be “experimental” and will not approve paying for this care.

The specific cancer treatment costs me over $15,000, which I had to pay on Friday from my 401(k). This amount will drain what I need for retiring. To remain as a full-time employee, I am having to use my 12 weeks of vacation time for this cancer treatment and receive my full pay.

Sherry said her office currently has patients on Original Medicare with a Medicare Supplement that is paying for this cancer claim. She files their claims without a problem. Toni, I need to know how to begin my Medicare benefits as quickly as possible. Please advise me what I need to do. Thanks, Toni.

—Brent from Nashville, Tenn.

Hello Brent:

A healthcare professional advised me that many of the new cancer procedures are not approved by individual and employer group health insurance plans. The doctor said that these procedures are generally approved with Original Medicare. He agreed with me that enrolling in Medicare past 65 and employed is complex, especially when an employee has the health issues you are currently experiencing, Brent.

Below are Medicare scenarios for enrolling in Original Medicare past 65, while employed and when leaving employer benefits. They are the same whether you’re still working, laid off or retiring:

—Health issues are not covered by an employer health plan: You (or your spouse) are still working, with health issues (like Brent), and the employer health insurance plan is not covering the doctor’s procedure. Even though you are not retiring, you need to enroll in Medicare.

—Laid off: You (or your spouse) are laid off and need to enroll in Medicare.

—Retiring past 65: You (or your spouse) decide to retire past 65 and need to enroll in Medicare.

The process to enroll in Medicare past 65 must be followed correctly, and is set out below:

—There are two Social Security forms to file: (1) The Medicare Request for Employment Information (CMS-L564) must be signed by the employer’s human resource representative for you and/or your spouse covered by employer benefits. (2) The request for Enrollment in Medicare Part B (Medical Insurance) (CMS-40B) must be filled out and signed by you (and your spouse if they are also enrolling in Medicare). These two forms are available at the Social Security website (www.ssa.gov/forms).

—At the top of each of these forms, it is very important to write “Special Enrollment Period” to inform the Social Security agent processing the form that you are signing up at the right time and prevent a Medicare Part B penalty. **If you have had two or more jobs since turning 65, then each of those companies must sign a CMS-L564 form.**

—Always make copies of your completed forms CMS-L564 and CMS-40B.

—It is important to deliver the original forms to your local Social Security office, especially when you want your Medicare to begin ASAP. There can be a delay in processing the forms when they are emailed or faxed. Keep your copies of the paperwork in case it is lost at the Social Security office.

Best of luck to you!

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Toni King is an author and columnist on Medicare, Social Security and long-term care issues. She has spent nearly 30 years as a top sales leader in the field. If you have a Medicare question, email info@tonisays.com or call 832-519-8664. Sign up for the Toni Says newsletter at www.tonisays.com to keep up to date on Medicare changes.

©2026 Toni King. Distributed by Tribune Content Agency, LLC.

Copyright 2026 Toni King, Distributed by Counterpoint Media