Social
Security
www.socialsecurity.gov
Social Security & Medicare:
2015 CMS National Training Program
Jeffrey C. Rodriguez
Public Affairs Specialist
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my Social Security
www.socialsecurity.gov/myaccount
my
my Social Security is an easy-to-access,
easy-to-use portal to view and update some
of your own Social Security information.
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Social Security Home Page
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History of SSA Programs
1935 – Retirement Insurance
1939 – Survivors Insurance
1956 – Disability Insurance
1965 – Medicare Program
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Other SSA Programs
 1972 – Supplemental Security Income
 2003 – Medicare Prescription
Drug Coverage
 2010 – Patient Protection and
Affordable Care Act
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Age to Apply
for Medicare
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Who Can Get Medicare ?
65 & older
-or-
24 months after entitlement to
Social Security disability benefits
-orAmyotrophic Lateral Sclerosis
-orPermanent kidney failure and receive maintenance dialysis
or a kidney transplant
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How to Apply for Medicare
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How to Apply for Medicare
Note
If you already have Medicare Part A and wish to
sign up for Medicare Part B only, please complete
form CMS 40-B, Application for Enrollment in
Medicare - Part B (Medical Insurance), and take
or mail it to your local Social Security office
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How To Apply for Benefits Based on a Spouse?
1. Call Social Security to schedule an appointment
1-800-772-1213 (TTY 1-800-325-0778); or
2. Apply at your local Social Security office.
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When Can I Sign Up for Medicare Part B?
Medicare Enrollment Periods:
 Initial – at age 65
 Special – if still working
 General – January-March
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SEP Terms
Group Health Plan (GHP)
 GHP plan based on current employment status
(beneficiary/spouse)
 GHP any size, for disabled plan is any size below 100
employees
 Types of GHP: self-insured, governmental entities,
employee organizational plans, employee pay-allplans, and national health plans in foreign countries.
 Does not include plans unavailable to employess
(S/E)
 Employer or employee doesn’t have to be in the
United States.
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SEP Terms
Health Savings Account (HAS)
 HSAs are NOT group health plans
 Individual must be covered under a high deductible
health plan (HDHP) and not entitled to Medicare
Part A.
 To be eligible for SEP for working aged or working
disabled, individual must have coverage under a
HDHP based on current employment
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SEP Terms
Current Employment Status
 An individual has “current employment status” if he
or she is actively working as an employee, is the
employer (including a self-employed individual), or
is associated with the employer in a business
relationship
 Individual covered under a retirement GHP is
rehired
 Employment Status of Senior Judges
 Clergy and members of religious orders
 Individuals serving as volunteers
 Directors of Corporations
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Income Related Monthly
Adjustment Amount (IRMAA)
MAGI Thresholds for 2011-2019
 IRS filing status: Married, filing jointly $170,00
 20IRS filing status: All other filing statuses $85,00
 Determined by Tax Year PY-2
Qualifying Circumstances

Death of spouse

Marriage

Divorce/Annulment

Work Reduction

Work Stoppage

Loss of income from income-producing property

Loss or reduction of certain pension income
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Medicare Billing
Four Methods
 Payment by a State under a buy-in agreement
 Deduction from a monthly Railroad Retirement
(RR) or Social Security benefit or Federal Civil
Service Retirement (CSR) annuity
 Direct remittances on an individual basis, or on
behalf of the enrollee
 Direct remittances on a group basis by an employee,
union, lodge or other organization, or by an entity of
a State or local government.
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Medicare Billing Cycles
Quarterly for Insured – not receiving benefits
 Cycles start for records selected on 27th of preceding month
 Example: bill mailed in July include premiums for August,
September and October. The next bill will be mailed in October.
Quarterly for Uninsured
 Cycles A, B, or C
 Cycle A starts in January
 Cycle B starts in February
 Cycle A starts in March
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Social Security
www.socialsecurity.gov
1-800-772-1213
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