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What You Need To Complete The Application For Help With Medicare Prescription Drug Plan CostsSSA Publication No. 05-10128, February 2008 ( View .pdf) (En EspaƱol) |
Social Security and the Centers for Medicare & Medicaid Services are working together to get you extra help with your prescription drug costs. To determine if you could be eligible for this extra help, Social Security will need to know your income and the value of your savings, investments and real estate (other than your home). To qualify for extra help:
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What you need to knowIdentify the things you own by yourself, with your spouse or with someone else, but do not include your home, vehicles, burial plots or personal possessions. Review all your income. Gather your records in advance to save time. Remember that this worksheet is not an application. This worksheet can assist you in completing the actual application for extra help. |
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Documents that will help you prepare in advance include:
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How you can get more informationFor more information about getting extra help with your Medicare prescription drug costs visit www.socialsecurity.gov or call Social Security at 1-800-772-1213 (TTY 1-800-325-0778). You can apply online for extra help. 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). Social Security representatives are available to help you complete your application. 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. |
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Please complete the worksheet below. 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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You may choose to have someone help you when you do business with Social Security. We will work with that person, just as we would work with you. |
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