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Get Medicare Part B Application Forms

E of this form is to provide documentation to Social Security that proves that you’ve been continuously covered by a group health plan based on current employment, with no more than eight consecutive months of lapses in coverage. There may be times when your former employer will be unable to fill out this form. For example, an employer may have gone out of business or may not have adequate records. If you are not able to get previous employers to fill out form L564, contact the Medicare Rights.

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