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| Medicare Extra Help Home Page | Understanding The Extra Help With Your Medicare Prescription Drug PlanSSA Publication No.05-10508, January 2010, ICN 470112 |
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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 Extra 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 can get Medicare prescription drug coverage. Some people with limited resources and income 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 the value of your savings, investments, and real estate (other than your home), and your income. 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 Extra Help with Medicare Prescription Drug Plan Costs (Form SSA-1020). Note: Beginning January 1, 2010, more Medicare beneficiaries may qualify for Extra Help because some things no longer count as resources and income. We will no longer count as a resource any life insurance policy; and we will no longer count as income the help you receive regularly from someone else to pay your household expenses—food, mortgage, rent, heating fuel or gas, electricity, water, and property taxes. Back to top] |
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What is the resource limit?To qualify for Extra Help, your total resources 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. |
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What is the income limit?To qualify for Extra Help, your annual income 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 may still 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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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 Extra Help with Medicare Prescription Drug Plan Costs (Form 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 Extra Help. If you are not eligible for the Extra Help, you may still 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 resources and income. 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 are eligible for Medicare. Anyone who has Medicare can get Medicare prescription drug coverage. If you have limited resources and income, you also may be able to get Extra Help to pay for the costs related to a Medicare prescription drug plan. The Extra Help will not affect the receipt of 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 resource and income limits for the Extra Help benefit. American Indians and Alaska Natives may have other resources and income that also are excluded. |
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Additional information for family members, caregivers, and third partiesYou can assist a Medicare beneficiary to apply for Extra Help with their Medicare prescription drug plan costs. If you assist someone 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 the value of their savings, investments, and real estate (other than their home), and their income. 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 at www.socialsecurity.gov/extrahelp. 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 Extra Help with Medicare Prescription Drug Plan Costs (Form SSA-1020). You also can visit your local Social Security office for assistance. |
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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 resources and income. 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?Beginning January 1, 2010, when you file your application for Extra Help, you also can start your application process for the Medicare Savings Programs—state programs that provide help with other Medicare costs. Social Security will send information to your state unless you tell us not to on the Extra Help application. Your state will contact you to help you apply for a Medicare Savings Program. These Medicare Savings Programs help people with limited resources and income pay for their Medicare expenses. The Medicare Savings Programs help pay for your Medicare Part B (medical insurance) premiums. For some people, the Medicare Savings Programs also may pay for Medicare Part A (hospital insurance) premiums, if any, and Part A and B deductibles and co-payments. If you think you might be able to get help from your state with Medicare costs, 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 phone at 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?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 resources and income, 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 can you get help to make a decision about enrolling in a specific prescription drug plan?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. When you call, you can request information about how to contact your State Health Insurance Assistance Program (SHIP). Your SHIP can help you with your Medicare prescription drug plans. You also can find your local SHIP contact information on the back of your Medicare handbook or obtain the information online at www.medicare.gov/contacts/staticpages/ships.aspx. |
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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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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 of receiving the pre-decisional notice, 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 how you can appeal if you disagree with the final determination. We call this an appeal. |
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How can you appeal the final 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/extrahelp 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 (Form 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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How can you get more information?For more information about getting Extra Help with your Medicare prescription drug plan costs, visit www.socialsecurity.gov/extrahelp or call Social Security at 1-800-772-1213 (TTY 1-800-325-0778). Social Security representatives are available to help you complete your application. If you need information about Medicare Savings Programs, Medicare prescription drug plans, how to enroll in a plan, or to request a copy of the Medicare & You handbook, please visit www.medicare.gov or call 1-800-MEDICARE (1-800-633-4227; TTY 1-877-486-2048). When you call, you can request information about how to contact your State Health Insurance Assistance Program (SHIP). Your SHIP can help you with your Medicare prescription drug plans. You also can find your local SHIP contact information on the back of your Medicare handbook or obtain the information online at www.medicare.gov/contacts/staticpages/ships.aspx. |
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