Social Security & Medicare Assistance

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Medicare

 

Medicare is the federally-funded medical plan for Americans age 65 and over that covers medical expenses such as doctor's visits, hospital stays, drugs and other treatment.  Over three million Floridians rely on Medicare for affordable healthcare.  My office assists many constituents with issues involving Medicare. Most often, we help with:

 

• Eligibility
• Claims
• Forms
• Supplemental insurance
• Prescription drug plans

 

If you are unable to resolve your problem through Medicare, my office may be able to assist you.  See below for further information or call a District office for help.  Before we can help you, you may need to fill out a Privacy Release Form.  

 

Medicare On-line:

 

• Application

• Medicare Beneficiary Information

• Medicare Plan Choices

• Prescription Drug Assistance Programs

• Medicare Physicians in Your Area

 

Medicare Basics:

 

Medicare is a health insurance program for

 

• People age 65 and older

• Some people with disabilities

• People with End Stage Renal Disease (ESRD)

 

Medicare is administered by the Centers for Medicare & Medicaid Services (CMS). Enrollment is handled by the Social Security Administration (SSA) For more information on Medicare, call:  1-800-MEDICARE

Medicare Offers the Following:

 

• Part A (Hospital Insurance)
  Assists with covering inpatient care in hospitals. This includes critical access hospitals and skilled nursing facilities. Part A helps cover skilled nursing facility care, hospice, and home health care. Individuals usually do not pay a monthly premium if Medicare taxes were paid while working.
• Part B (Medical Insurance)
  Helps cover doctor’s visits, outpatient care, durable medical equipment, and other medical services. Part B also helps cover some preventive benefits.
• The Social Security Administration handles initial enrollment for Part A and Part B.
• Part C (Medicare Advantage Plans)
  An alternative to Original Medicare. Part C combines Part A, Part B, and Part D. The health plans are approved by Medicare and administered by private insurance companies. Part C’s premiums vary and it offers the same coverage as Original Medicare.
• The Medicare Insurance Provider handles Medicare Part C.
• Part D (Prescription Drug Coverage)
  Helps pay costs of prescription drugs. The coverage varies and the user will incur out of pocket expenses such as co-payments, coinsurance, and deductibles. Extra assistance is available and is based on limited income and assets.
• Medicare Part D is handled by the Centers for Medicare & Medicaid. Social Security administers a low income subsidy for Medicare Part D claims. 

 

Frequently Asked Questions About Medicare:

 

How can I enroll in Medicare?

• If you are already receiving Social Security when you turn 65, you will automatically get both Medicare Part A and Part B on the first day of the month in which you turn 65. A card will be mailed to you about three months before your birthday. The Medicare card is red, white and blue and will include your name and Medicare number.
• If you are not receiving Social Security when you turn 65, you should go to your local Social Security office to enroll in Medicare three months before your 65th birthday. You have seven months to enroll in Medicare without penalties starting three months before the month you turn 65. In some cases, you can avoid the penalty if you or your spouse is still working. Call 1-800-772-1213 for the address of your local Social Security office.
• If you are disabled and have been receiving Social Security Disability Insurance (SSDI) for at least 21 months, you should get your Medicare card three months before you become eligible for Medicare. If you have kidney disease, you should enroll at your local Social Security office. If you have ALS, you will become eligible for Medicare as soon as you begin receiving Social Security disability benefits.
• To enroll in Part D, Medicare's drug coverage, you have to join a Medicare private drug plan offered in your area. For most people, enrollment in Part D is optional. When deciding whether to join a Medicare private drug plan, you might find the drug plan comparison search on www.medicare.gov helpful, or you can call 1-800-MEDICARE.

 

How do I obtain a replacement Medicare card?

• You may contact your local Social Security Administration office or call the National Hotline at 1-800-772-1213.

 

How do I appeal a claims decision that I am not satisfied with?

• After a decision has been rendered, you will receive a Medicare Summary notice explaining whether your claim was approved or denied. If your claim has been denied, all appeal rights will be explained within the notice. Simply follow the directions contained within the notice.

 

How do I report an instance of fraud?

• If you believe Medicare has been billed for services you did not receive or Medicare has been over billed always contact your provider first to make sure a mistake has not been made. After you contact your provider, if you still believe fraud exists, contact Medicare's fraud hotline at 1-800-447-8477 or contact my office.

 

How do I determine if a particular nursing home is appropriate for my loved one?

• Medicare and the Centers for Medicare and Medicaid Services (CMS) provides a service called Nursing Home Compare. Nursing homes are rated by Medicare and CMS by the quality of care they provide. Medicare offers On-line information about nursing homes at its website, as well as numerous publications. If you do not have internet access, contact Medicare at 1-800-MEDICARE to obtain additional information.

 

How can I obtain additional assistance paying for prescription drugs?

• If you are a Medicare Part D beneficiary who has reached the "donut hole" -- the point at which you pay the full cost for prescription drugs out-of-pocket -- you may be eligible for an immediate tax-free $250 payment to ease high drug costs.  Please click here for more information.

 

What if I am a Railroad Retiree?

• If you are a Railroad Retiree and are trying to obtain Medicare benefits, you will need to contact the Railroad Retirement Board Helpline at (800) 808-0772 or visit the Railroad Retirees website.