If you just want to see the application form for extra help, you can view a sample at www.socialsecurity.gov/prescriptionhelp. There you also can find instruction sheets in 15 different languages to help you understand the English application.
If you wish to apply for extra help with Medicare prescription drug plan costs, we recommend that you use our online application at www.socialsecurity.gov/i1020/
If you prefer not to fill out this application on the Internet, you can call our toll-free number, 1-800-772-1213 to ask for a paper application or to make an appointment to apply for extra help with Medicare prescription drug plan costs. If you are deaf or hard of hearing, call our toll-free TTY number, 1-800-325-0778. Representatives are available Monday through Friday from 7 a.m. to 7 p.m. Tell the representative that you want to apply for extra help with Medicare prescription drug costs.
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