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Understanding The Extra Help With Your Medicare Prescription Drug PlanSSA Publication No.05-10508, April 2009, ICN 470113 |
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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). We treat all calls confidentially. 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 TTY number, 1-800-325-0778. 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 and lives in the 50 states or the District of Columbia 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 is estimated to be worth an average of $3,900 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). 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 for 2009 must be limited to $16,245 for an individual or $21,855 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 for 2009 must be limited to $12,510 for an individual or $25,010 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?Most of the questions on the application deal with income and resources. If you are married and living with your spouse, we need to know this information about both of you. Family members, caregivers, and other third parties can help you complete the application. The worksheet on the next page can help you decide if you are eligible and can assist you in completing the actual application for Extra Help. The worksheet is not an application. To prepare:
The records you will need are:
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.
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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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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 also are eligible for Medicare. Anyone who has Medicare and lives in the 50 states or the District of Columbia can get Medicare prescription drug coverage. This help will not affect your monthly disability payments. |
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Additional information for American Indians and Alaska Natives
Certain 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. |
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Additional information for family members, caregivers and third partiesYou can help a Medicare beneficiary apply for Extra Help with their Medicare prescription drug plan costs. If you assist someone else with the application, you must answer the questions as if that person were completing the application. 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. The information on page 9 and worksheet on page 10 can assist you with the application. You can help someone apply for Extra Help online. To help them apply by phone or to get an original paper 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). |
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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. Just call our toll-free number or apply at your local Social Security office. 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 state agencies help you with Medicare costs?State agencies also can help with Medicare costs. State medical assistance (Medicaid) offices offer a Medicare Savings Program. Medicare Savings Programs also help 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 call 1-800-MEDICARE (1-800-633-4227; TTY 1-877-486-2048). |
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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 website—Join a drug plan at www.medicare.gov on the web using Medicare’s online enrollment center. 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. |
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What factors should you consider when comparing your Medicare drug plan choices?Visit www.medicare.gov on the Internet 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 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. 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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How can you get help to make a decision about enrolling in a specific prescription drug plan?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 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. |
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How do we make a decision on your application for Extra Help?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 |
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How can you appeal the final determination we made on your application for Extra HelpIf 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 at 1-800-772-1213 (TTY 1-800-325-0778) and ask for an 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? 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 time frame for the appeal? Can you get help to request an appeal? What can you do if you do not agree with the decision made on your appeal? |
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Legislative changesIn July 2008, Congress passed the Medicare Improvement for Patients and Providers Act. This legislation made three key changes to the Extra Help benefit with Medicare prescription drug plan costs, effective January 1, 2010:
Also, if you are receiving Extra Help you are not subject to a penalty for late enrollment into the Medicare Part D prescription drug program. This provision is effective January 1, 2009. So, the sooner you apply the sooner you begin receiving benefits.
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