What should you know about the application for extra help?

We developed a form to apply for extra help that you can complete. Family members, caregivers and other third parties also can help you complete the application. The worksheet on the next page can assist in completing the application. The worksheet is not an application .

To prepare:

The records you will need are:

We need to know information about your (and your spouse’s, if you are married and living together) income and resources.

[Back to top]

Tips for completing the application 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.

[Back to top]

How do you answer question 5 about life insurance: face and cash values?

For Question 5 on the application, we need to know whether you (or your spouse, if you live together) have any life insurance policies with a total combined face value of more than $1,500. The face value is the same as the death benefit—the sum of money that is paid when you die. If you answer “Yes” to Question 5, you must report the cash value—that is the amount you would receive if your insurance policy was cashed in right now—even if it is less than the face value. Important note: If you have any outstanding loans against the policy, the cash value is reduced.

Social Security will accept your statement concerning the cash value of your life insurance policy and will not require any further documentation.

Do all policies count?

No. In determining whether the combined face values (death benefits) of all your life insurance policies exceed $1,500, Social Security will not count:

Will insurance companies be able to help?

Yes. Insurance companies are aware of the Medicare prescription drug program and have been informed that they may receive inquiries concerning cash values from policyholders or people who are assisting them to apply for the extra help.

[Back to top]

How do you answer question 11 about help with household expenses?

Question 11 on the application asks if you count on anyone to help you pay for any of the following household expenses—food, mortgage, rent, heating fuel or gas, electricity, water and property taxes. If we do not need to verify the amount, we will accept the amount you put on the application.

If anyone regularly provides you or your spouse, if married and living together, help with these expenses, answer “Yes” and enter the average monthly amount in the space provided on the application. If you occasionally receive help, such as your child paying your telephone bill for one month, do not include that amount. The kind of help that we count would be if somebody regularly pays for your food or shelter, such as your niece buying all your groceries or paying your rent regularly. Small amounts of money you receive occasionally or unexpectedly do not count.

Are there certain types of assistance that do not count?

Yes. There are exceptions. The following are examples of assistance that we do not count :

[Back to top]

How can state agencies help with Medicare costs?

State medical assistance (Medicaid) offices offer a Medicare Savings Program. The Medicare Savings Program also helps people with limited income and resources pay for their Medicare expenses. If you are paying a premium for Medicare Part A, the Medicare Savings Program may pay it for you. The Medicare Savings Program can help you save more than $1,100 a year. This assistance is in addition to the extra help.

If you think you might be able to get help with Medicare costs from your state, or if you are not sure, call your state medical assistance (Medicaid) office or 1-800-MEDICARE (1-800-633-4227; TTY 1-877-486-2048).

[Back to top]

Additional information for Medicare beneficiaries with disabilities

If you are disabled and have been receiving Social Security disability benefits for 24 months, have permanent kidney failure that requires maintenance dialysis or a kidney replacement, or have amyotrophic lateral sclerosis (Lou Gehrig’s disease), you are eligible for Medicare. Anyone who has Medicare can get Medicare prescription drug coverage. And, there is extra help available for people with limited income and resources. The extra help will pay for all or most of the monthly premiums and annual deductibles and lowers the prescription co-payments related to a Medicare prescription drug plan. This help will not affect your monthly disability payments.

[Back to top]

Additional information for American Indians and Alaska Natives

Additional information for family members, caregivers and third parties

You can help someone you care about apply for extra help with their Medicare prescription drug plan costs. Anyone who has Medicare can get Medicare Prescription Drug coverage. Extra help is available for people with limited income and resources and will pay for part of the monthly premiums, annual deductibles and prescription co-payments related to their plan. The extra help could be worth up to $3,600 per year. Many people with limited income and resources qualify for these big savings and don’t even know it. To find out if someone is eligible, Social Security will need to know their income and the value of their savings, investments and real estate (other than their home). If they are married and living with their spouse, we will need this information for both of them.

Social Security can give you an application for extra help, so you can help a Medicare beneficiary apply. The worksheet above can assist you with the application. The worksheet is not an application.

Ask whoever you are helping to:

Documents that will help you prepare in advance for anyone you are helping:

Additional information for state and county legislators

Congress gave Social Security the responsibility to help the public understand that they may be eligible for extra help with their Medicare prescription drug plan costs. Social Security, as well as state governments, has a role in helping people apply for the extra help and processing their applications.

Social Security designed a simplified application so that caregivers and third parties can assist people when they apply for extra help. Social Security does not want this population to have to travel to a Social Security field office. There are several ways for people to apply. They can:

You can arrange to meet with Social Security representatives by contacting Social Security’s Regional Communication Directors. A listing is provided on our website at http://www.socialsecurity.gov/pressoffice/natlpocontacts.html. You can find more informational materials at www.socialsecurity.gov/medicareoutreach2.

[Back to top]

How do we make a decision on your claim?

Social Security will use the information you provide on your application to determine your eligibility. We also will compare that information with records from federal, state and local government agencies to make sure the information is correct.

What can you do if you disagree with the information we used to determine your eligibility?

Social Security will send you a pre-decisional notice if information in our records show you are ineligible for the extra help. If you don’t understand the notice, call us at 1-800-772-1213 (TTY 1-800-325-0778), and we will explain it to you. If you disagree with the information we have, call the number above or visit your local Social Security office within 10 days and give us the correct information.

We will send you a final determination if you do not provide us any additional information within 10 days. It will explain what you should do if you disagree with the determination. We call this an appeal.

[Back to top]

How can you appeal the determination we made on your application for extra help?

If you want to appeal the determination Social Security made about your eligibility for extra help with Medicare prescription drug plan costs, visit www.socialsecurity.gov or call us 1-800-772-1213 (TTY 1-800-325-0778) and ask for a Request for Appeal of Determination for Help with Medicare Prescription Drug Plan Costs (SSA-1021).You can mail the request to Wilkes-Barre Data Operations Center, P.O. Box 1030, Wilkes-Barre, PA 18767-1030. You also can call, write or visit your local Social Security office

What will happen when you appeal?

When you request the appeal, we will ask you to tell us why you think our decision is wrong. Usually we will set up an appointment for a hearing, to review your case with you by telephone. To set up the hearing appointment, we will ask you for two preferred times for us to call. Then, we will send you a hearing appointment notice that will give you the time and date scheduled for your hearing.

If you choose not to participate in a telephone hearing, we will decide your case by looking at the information we have on file and any new information you give us to be sure that a proper decision was made. We call this a hearing by case review.

Is there a timeframe for the appeal?

You have 60 days from the date you receive the notice telling you about our decision to request an appeal. If you do not appeal within the 60-day time limit, you may lose your right to appeal and the decision we made becomes final. If you have a good reason for not appealing your case within the time limits, we may give you more time. You can request an extension by calling us at 1-800-772-1213 (TTY 1-800-325-0778).

Can you get help to request an appeal?

You may choose to have someone help you with your appeal or to represent you. Your representative may be a lawyer or other qualified person familiar with you and the Social Security program. We will work with your representative just as we would work with you. He or she can act for you in most Social Security matters.

What can you do if you do not agree with the decision made on your appeal?

If you disagree with the decision Social Security makes on your appeal, you may file a lawsuit in a federal district court. The letter we send you about the decision on your appeal also will tell you how to ask a court to look at your case.

[Back to top]

How can Social Security help you with the Medicare prescription drug plans?

Social Security can help you apply for extra help paying for your Medicare prescription drug plan costs if you have limited income and resources.

[Back to top]

How can you get help to make a decision about enrolling in a specific prescription drug plan?

Visit www.medicare.gov and use the following tools:

• Compare Medicare prescription drug plans— By entering personalized information, you can find and compare the prescription drug plans in your state that meet your personal needs and enroll in the prescription drug plan that you select.
  
  
• Formulary Finder— By entering personalized information about the specific medications you take, you can get information to help you find the plans in your state that match your prescription drug needs.

[Back to top]

What factors should you consider when comparing your Medicare drug plan choices?

• Coverage — Medicare drug plans will cover generic and brand-name drugs. Most plans will have a formulary, which is a list of drugs covered by the plan. The drugs covered by the plans can change, but the list must always meet Medicare’s requirements.
  
  
• Cost — Monthly premiums and your share of prescription costs will vary depending on which plan you choose. If you qualify for extra help with these costs because you have limited income and resources, you will get help with some or all of these costs.
  
  
• Convenience — Drug plans must contract with pharmacies in your area. Check with the plan to make sure the pharmacies in the plan are convenient to you.

[Back to top]

How do you join a Medicare prescription drug plan?

• By paper application —Contact the company offering the drug plan you choose and ask for an application. Once you fill out the form, mail or fax it back to the company.
  
  
• On the plan’s website —Visit the drug plan company’s website. You may be able to join online.
  
  
• On Medicare’s online enrollment center —Join a drug plan at www.medicare.gov.
  
  
• By calling 1-800-MEDICARE —Call 1-800-MEDICARE (1-800-633-4227; TTY 1-877-486-2048) and talk to a Medicare customer service representative.

[Back to top]

What should you do next?

You can apply online for extra help with Medicare prescription drug plan costs. To apply by phone or get an application, call Social Security at 1-800-772-1213 (TTY 1-800-325-0778) and ask for the Application for Help with Medicare Prescription Drug Plan Costs (SSA-1020).

To learn more about the Medicare prescription drug plans and special enrollment periods visit www.medicare.gov or call 1-800-MEDICARE (1-800-633-4227). Medicare also can tell you about agencies in your area to help you with Medicare prescription drug plans.

[Back to top]