Tips For Completing The Application For Help With Medicare Prescription Drug Plan Costs

Filing for Extra Help? Here are some tips to help you complete the application. Following these tips will help us process your application as quickly as possible.

• Computers read your application when you send it back to Social Security. Use only a pen with black ink. Pens with ink of any color other than black cannot be read by the computer and could cause a delay in getting you an answer about your application for extra help.

  • Many questions on the application ask you to mark an “X” in a “Yes” or “No” box. Please remember that you cannot mark an “X” in both the “Yes” and “No” boxes.

  • Your Social Security number or Railroad Retirement Board number must be included on the application. In order to receive a quick response from us, please be sure you enter your name and number exactly as they appear on your Social Security card or Railroad Retirement Board card.

  • If you are single, widowed, divorced or not living with your spouse, do not complete question 2 (marital information), and do not write in any boxes anywhere on the form that ask for information about your spouse.

  • If you answer “Yes” to question 5 (life insurance), please make sure you provide the cash value. The cash value is the amount you would receive if your insurance policy was cashed in right now—even if it is less than the face value. If you don’t know the cash value of your life insurance policy, call your insurance company to get this information.

  • Please send the entire application package back to us—not just the page that you signed. If you are unable to answer all the questions, send your application and we will help you complete it.

  • There is no need to send us anything other than your completed application. We do not need to see doctor bills, prescription lists, Internal Revenue Service (IRS) forms or other documents.

• Complete either the online application form or a scannable paper form, which you can get from any Social Security office or by calling us at 1-800-772-1213 (TTY 1-800-325-0778). Please do not complete a photocopied, faxed or downloaded copy of the application. Anything other than the online or original paper application could cause a delay in getting you an answer about your application for extra help..
  
• If relatives, neighbors or friends want an application, have them complete either their own online application form or call 1-800-772-1213 (TTY 1-800-325-0778) and ask for an application. Please do not share your application with them.

Remember to consider income and resources

• If your annual income is below $15,600 for an individual ($21,000 for a married couple living together), you may not have to pay monthly premiums or deductibles, and you could pay as little as $2.25 for your co-payments.
  
  
• Even if your annual income is higher, you still may be able to get some help with your monthly premiums, annual deductibles and prescription co-payments. For example, your income may be higher and you possibly could get extra help if you or your spouse:
  
  • Support other family members who live with you;
  • Have earnings from work; or
  • Live in Alaska or Hawaii.
    
    
• To qualify, your resources must be limited to $11,990 for an individual ($23,970 for a married couple living together). Resources include such things as bank accounts, stocks and bonds. We do not count your house and car as resources.