Medicare & Medicaid
Social Security Administration & CMS
Can Congressman Peters Help Me?
My office can help you with determining Social Security benefits, as well as Supplemental Security Income (SSI) and Medicare eligibility. We can make an inquiry to request the status of your pending claim or submit a request for expedited review on your behalf. However, the Office of Disability Adjudication and Review (ODAR) determines if a case is “critical” and requires special processing under specific situations.
We can help you:
- Obtain an update on a pending application
- Request information on your program eligibility
- Clarify matters involving your benefits
- Facilitate communication between a provider and CMS to resolve reimbursement and other matters
- Cannot force SSA or CMS to approve or reimburse an application or claim
- Cannot expedite appeals unless approved “dire need” as defined by the respective agency
- Cannot file your application for you
To begin the process, please complete, print & sign the privacy release form below. Completed forms should be emailed to RepScottPetersPAW@mail.house.gov or mailed to our office at 4350 Executive Dr., Suite 105, San Diego, CA 92121. Once we have the form, we can begin to work on your case.
As we address your concerns, please keep in mind that we cannot force an agency to act in your favor. The rules of the U.S. House of Representatives do not allow us to intervene in, or influence the outcome of, cases that are under the jurisdiction of any court. Finally, our office cannot intervene in matters under the jurisdiction of local, state, or foreign governments.
Below are some frequently asked questions about seniors benefits. If that does not answer your question, click below to request help from our office. We look forward to helping you!
Health Insurance Counseling & Advocacy Program (HICAP) provides free and objective information and counseling about Medicare. Volunteer counselors can help you understand your specific rights and health care options. HICAP also offers free educational presentations to groups of Medicare beneficiaries, their families and/or providers on a variety of Medicare and other health insurance related topics. For more information, please visit: https://www.aging.ca.gov/hicap/
San Diego County HICAP office
Elder Law & Advocacy
5151 Murphy Canyon Road, Suite 110
San Diego CA 92123
(858) 565-8772– San Diego
(760) 353-0223– Imperial
Fax (858) 565-1394
Hours: Monday – Friday, 8 to 5
Seniors Frequently Asked Questions
For general questions regarding Medicare or Medicaid, visit Medicare.gov and CMS.gov. For local resources on Medicaid, visit HealthInsurance.org. For general questions regarding Social Security, visit SSA.gov.
For information on how to protect yourself from scams, view our Senior Scam Stopper guide.
Can you help me get my Social Security disability approved?
While my office can make an inquiry on your behalf about the status of a pending case, or for clarification on the reasons for a denial, it would be inappropriate for me to compel any agency to decide an issue in your favor, or to overturn a decision that is final.
Can you help me expedite my Social Security disability claim?
I can make an inquiry to request the status of your pending claim or submit a request for expedited review on your behalf. However, the Office of Disability Adjudication and Review (ODAR) determines if a case is “critical” and requires special processing under specific situations.
To learn more about criteria for expedited requests, visit: http://www.ssa.gov/OP_Home/hallex/I-02/I-2-1-40.html
Do I qualify for disability and SSI?
Use Social Security's Screening Tool (BEST) to check if you do.
What is the difference between Part A and Part B, and what do they cover?
Medicare Part A is known as hospital coverage. Part A covers inpatient hospital care, inpatient care in a skilled nursing facility following a hospital stay, some home health care, and hospice care. If you paid FICA taxes while you were working, Part A coverage is free except for coinsurance and deductibles.
Medicare Part B covers outpatient services. These services include doctors' services, diagnostic tests, durable medical equipment, ambulance service and many other health services and supplies not covered by Medicare Part A. In order to sign up for Part B coverage, you must be 65 years of age and pay a monthly premium. You may sign up for Part B by contacting your local Social Security office.
Please note that Medicare does not cover custodial (bathing, personal care services, help eating) care in or out of a nursing home.
Can your office assist me if I am having difficulty with my Part D prescription drug plan?
You should first call your prescription plan or 1-800-Medicare to try to resolve the problem. If you are still having difficulty, please call my district office and my staff will try to help you resolve the problem.
Where can I learn more about the Medicare Part D Prescription drug plans offered?
You can visit www.medicare.gov and navigate through the Medicare Prescription Drug Plan Finder to view plan prices and research which plan is best for you. I also recommend utilizing some of the local resources available to get individual advice from trained professionals about your options.
What if Medicare refuses a claim and I disagree with them?
You have the right to appeal. Information on the appeal process would be included in any denial decision you receive. You may contact my office for assistance with this process.
My Medicare HMO has discontinued my coverage. What do I do?
A. You have 63 days from the time your HMO coverage ends to purchase supplemental insurance (Medigap) and be guaranteed coverage. During that period, no insurance company may deny you Medigap coverage based on your age or health status. However, prices may vary. For more information on Medigap, call Medicare at 1-800-633-4227.
Additionally, you may want to contact the Area Agency on Aging at 1-800-852-7795.for assistance with exploring your options.
I am having trouble affording coverage. Are there any programs that can help pay for my coverage?
Yes. If your monthly income is below a certain level, you may qualify for a Medicare Savings Program that would pay some of your deductibles and coinsurance. To check if you qualify, and for more information about the Medicare Savings Program, please call 1-800-642-3195.
Can I delay my Medicare Part B enrollment without paying higher premiums?
Yes. If you or your spouse has group health insurance from an employer or union, you may be able to delay enrolling in Part B without having to pay higher premiums. However, exceptions are very limited, so be sure to check with your Social Security Office before you decide not to enroll at 65.