Which Federal Agency Will Answer My Medicare Question?

Q. I notice that sometimes you advise people to contact Social Security about Medicare. When we need specific information about Medicare, which agency should we contact?

A. This bureaucratic division between the two federal agencies, which consumers often find confusing, has its roots in history. When Medicare began in 1966, the whole program was run by the Social Security Administration (SSA). Later, the federal government created a separate agency—now known as the Centers for Medicare & Medicaid Services (CMS). Today SSA still administers some functions of Medicare, such as enrollment, whereas CMS runs others, such as coverage policies.

Here’s a rule of thumb for which agency you’d contact in different circumstances.

Contact the Social Security Administration for help and information on:

• Eligibility for Medicare.
• Enrolling in Medicare Part A (hospital insurance) and Part B (doctors’ visits and other outpatient services).
• Disenrolling from Part B.
• Applying for the low-cost “Extra Help” benefit under the Medicare Part D prescription drug program if your income is low.
• Paying a higher Part B premium if your modified adjusted gross income is over a certain level.
• Obtaining a replacement Medicare card.
• Reporting a change of address.
• All questions relating to Social Security retirement and survivor benefits, disability benefits (SSDI), and Social Supplementary Income (SSI).

SSA contacts:

Phone: 1-800-772-1213

TTY/TDD phone: 1-800-325-0778

Website: www.ssa.gov. Click on the “Medicare” tab at the top of the home page. The website includes general information, frequently asked questions, and online application forms for certain benefits, such as Extra Help for assistance paying for prescription drug costs. The site can be read in 15 languages as well as English. (Note that some web browsers do not support this site. If you have difficulty reading it, switch to a common browser such as Internet Explorer, Mozilla, Firefox, Safari, etc.)

Contact the Centers for Medicare & Medicaid Services for help and information on:

• Medical services that Medicare covers.
• Choosing a Medicare Part D drug plan.
• Choosing a Medicare Advantage health plan.
• Choosing private Medicare supplemental insurance (Medigap).
• Finding a provider (physician, hospital, etc.) that accepts Medicare patients in your area.
• Finding a Medicare-approved medical equipment supplier in your area.
• Comparing the quality of hospitals, nursing homes, and home health agencies.
• Questions about Part D’s Extra Help program if you qualified for it automatically and didn’t have to apply.
• Questions about billing for Medicare services.
• Appealing a coverage or payment decision you don’t agree with.
• Getting help to pay Part B premiums through a Medicare Savings Program if your income is low.
• Reporting fraud.

CMS contacts:

Phone: 1-800-633-4227

Toll-free TTY/TDD phone: 1-877-486-2048

Website: www.medicare.gov. The website provides information on all Medicare matters and can be read in either English or Spanish. It also includes useful online tools for comparing Medicare’s private health and prescription drug plans. For details on many specific topics (for example, home health care, choosing a Medigap policy, how Medicare’s private health plans work, etc.), check out the “Find a Medicare Publication” link on the home page.

Patricia Barry is a senior editor at the AARP Bulletin.