What’s The Link Between SSA And Medicare?

Question: I have to sign up for Medicare, where do I do that? What does the Social Security Administration have to do with signing up for Medicare?

Answer: I hear this question a lot and answer it often, but never in my articles. I guess now is the perfect time.

The Social Security Administration (SSA) and the Center for Medicare & Medicaid Services (CMS) are both Federal Governmental agencies. They have very different roles, but there is some crossover between the two of them. Recently the SSA.gov Blog had a nice article clarifying who to contact for what with regard to these topics, so I am using some of that information in this article.

CMS does not have local offices throughout the United States. They are a major presence in the Washington, D.C., with some regional offices throughout the country, but not in every state or county, like the SSA offices. Therefore, CMS and SSA have collaborated to do some work for each other. That work has to do with the process of signing up for Medicare.

Currently, when you are ready to sign up for Medicare, the sign up process is handled by SSA. It can be done a number of ways: using the SSA.gov website, calling SSA (locally or nationally), or by walking into a SSA.gov office. At one time many years ago, there were Medicare Representatives working in each SSA office to help with Medicare related questions. I cannot tell you exactly when or why that stopped being the case.

SSA staff and website can help you find information related to Medicare in a general way and also in a very specific way for you personally. The SSA.gov website and the staff can help you determine if you are eligible for Medicare, change your address, your name, or your phone number. You can sign up for Medicare Part A and Part B at SSA or SSA.gov. You can find out information about the Income-Related Monthly Adjustment Amount (IRMAA) for those individuals who are impacted by this higher Medicare Part B and Part D premium. You can also correct IRMAA related adjustments to your income. Lastly, you can apply for Extra Help, which is a way of getting help paying for your Medicare Part D premiums and co-pays for your medications. Those individuals who make less than $1,538 per month and with resources less than $14,100, or couples who make less than $2,078 and with resources less than $28,150 qualify for this benefit. This benefit is also sometimes called the Low Income Subsidy or LIS Benefit.

The above examples are mostly initial Medicare enrollment related issues.

Social Security also can help get you a new Medicare card. We all know these Medicare cards are paper cards. They may not last your lifetime, they can get ripped or washed or worn out. You can request a new Medicare Card anytime you need one, at a Social Security Office, or by calling SSA or by going to the SSA.gov website.

What the Social Security Administration (SSA) cannot do, is help you find a Prescription Drug Plan (Part D) or help you sign up for other insurance products. SSA also cannot explain if Medicare will cover a particular procedure your doctor is recommending.

Once you have Medicare Part A & B and are using that insurance, most of the questions you have should be directed to Medicare. Medicare can be reached at .medicare.gov or 800-633-4227.

When you call Medicare directly, you can ask questions about what Medicare covers, find out about claims processed on your behalf, find providers in your area who participate in Medicare, etc. Medicare can also give you ratings about providers. Medicare can help you file for an appeal about benefits denied. Medicare can also help you find additional insurance information, like drug coverage, or Medicare Advantage Plans or Medicare Supplement Plans. They also can help you find information about how these plans are rated.

Medicare can also provide you with written information about services, coverage and claims related to almost anything Medical. These materials come in many different languages. These materials can be ordered and mailed right to you, or reviewed and saved online or saved on your computer.

Both SSA and Medicare have on-line portals you can use to reach specific information related to you and your personal issues. This process requires creating passwords and logins for the myssa.gov website or the myMedicare.gov portals. These can be very useful if you are comfortable using a computer and have a secure location to do this kind of business.

It is significant to remember that when contacting SSA, you do not have to contact the SSA office in your area. You can go to any SSA office to get help. Social Security Benefits and Medicare are both Federal Benefits, so you can use any location for your business. It is important to remember that once your process has started, it makes sense to continue to use the same SSA office to finish your business, so that your documents and contacts are consistent.

I hope this has been helpful in clearing up what can be done at Social Security Administration (SSA) and what can done with Medicare.

To contact Janell Sluga, GCMC with questions or concerns, please call 720-9797 or e-mail her at janells@lutheran-jamestown.org.

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