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Understanding The Extra Help With Your Medicare Prescription Drug PlanSSA Publication No.05-10508, February 2008, ICN 470113 |
Contacting Social SecurityVisit our website Our website, www.socialsecurity.gov, is a valuable resource for information about all of Social Security’s programs. At our website, you can:
Call our toll-free number If you need an application, call Social Security at 1-800-772-1213, and ask for the Application for Help with Medicare Prescription Drug Plan Costs (SSA-1020). Social Security representatives are available to help you complete your application or answer specific questions from 7 a.m. to 7 p.m., Monday through Friday. We provide information by automated phone service 24 hours a day. If you are deaf or hard of hearing, you can call our, 1-800-325-0778. We treat all calls confidentially. We also want to make sure you receive accurate and courteous service. That is why we have a second Social Security representative monitor some telephone calls. |
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What is extra help with Medicare prescription drug plan costs?Anyone who has Medicare can get Medicare prescription drug coverage. Some people with limited income and resources also are eligible for extra help to pay for the costs—monthly premiums, annual deductibles and prescription co-payments—related to a Medicare prescription drug plan. The extra help could be worth up to $3,600 per year. Many people qualify for these big savings and don’t even know it. To find out if you qualify, Social Security will need to know your income and the value of your savings, investments and real estate (other than your home). If you are married and living with your spouse, we will need information about both of you. To help Social Security determine if you are eligible for the extra help, you will need to file an Application for Help with Medicare Prescription Drug Plan Costs (SSA-1020). Most of the questions on the application deal with income and resource. We will not ask for documentation initially to support the information you provide, but we will match your information with data available from other federal agencies. Back to top] |
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What is the income limit?To qualify for extra help with Medicare prescription drug plan costs, your annual income must be limited to $15,600 for an individual ($21,000 for a married couple living together). Even if your annual income is higher, you still may be able to get some help. Some examples where your income may be higher are if you or your spouse:
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What does not count as income?Not all cash payments count as income. For example, we do not count :
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What is the resource limit?To get the extra help, your total resources must be limited to $11,990 for an individual ($23,970 for a married couple living together). Resources include the value of the things you own. Some examples are:
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What does not count as a resource?We do not count:
You should contact Social Security for information about other exclusions. [Back to top] |
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How do you apply?If you are not getting the extra help automatically, it is easy to apply. Just complete Social Security’s Application for Help with Medicare Prescription Drug Plan Costs (SSA-1020). Here’s how:
After you apply, Social Security will review your application and send you a letter to let you know if you qualify for the extra help. Once you qualify, you can select the Medicare prescription drug plan of your choice. If you do not select a plan, the Centers for Medicare & Medicaid Services will do it for you. The sooner you join a plan the sooner you begin receiving benefits. If you are not eligible for the extra help, you still may be able to enroll in a Medicare prescription drug plan. For information about enrollment periods visit www.medicare.gov or call 1-800-MEDICARE (1-800-633-4227; TTY 1-877-486-2048). [Back to top] |
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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.
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Tips for completing the application for extra helpHere are some tips to help you complete the application. Following these tips will help us process your application as quickly as possible.
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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. If you do not know the amount of your policy’s cash value, you may need to contact your life insurance agent or company to get this information
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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 :
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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). |
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Additional information for Medicare beneficiaries with disabilitiesIf 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. |
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Additional information for American Indians and Alaska NativesCertain incomes and resources that do not count toward the income and resource limits. American Indians and Alaska Natives may have other income and resources that also are excluded.For example, Social Security will not count the following income and resources:
You should contact Social Security for other income and resource exclusions. |
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Additional information for family members, caregivers and third partiesYou 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:
State agencies also may be able to 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 the person you are helping is paying a premium for Medicare Part A, the Medicare Savings Program may pay it for them. The help they get from the Medicare Savings Program can save them more than $1,100 a year. This assistance is in addition to the extra help. If you think they might be able to get help with Medicare costs from their state, or if you are not sure, call their state medical assistance (Medicaid) office or 1-800-MEDICARE (1-800-633-4227; TTY 1-877-486-2048). What you should do next You can help someone apply for extra help online. To help them 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; TTY 1-877-486-2048). Medicare also can tell you or the loved one you care for about agencies in your area that can help with Medicare prescription drug plans. |
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Additional information for state and county legislatorsCongress 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:
To support our application process Social Security has undertaken a major public educational and outreach campaign. We have held thousands of events and trained thousands of organizations and state agencies to assist in our outreach efforts. We have worked with Medicaid personnel, State Pharmacy Assistance Programs (SPAPs), State Health Insurance Assistance Program (SHIP) Directors and various community organizations providing training, instructional materials, pamphlets and posters when needed. We will continue to provide any necessary training or materials you need. 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.
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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. |
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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. Whether you request a hearing by telephone or a hearing by case review, we will send you another notice as soon as the necessary work has been completed on your claim
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.
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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. Social Security can provide information about the organizations that are available in your community to help you make choices when enrolling in a plan.
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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:
Call 1-800-MEDICARE (1-800-633-4227; TTY 1-877-486-2048) to learn more about the Medicare prescription drug plans and special enrollment periods. Medicare can tell you about agencies in your area that can help you with Medicare prescription drug plans. |
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What factors should you consider when comparing your Medicare drug plan choices?
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How do you join a Medicare prescription drug plan?
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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
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