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Understanding The Extra Help With Your Medicare Prescription Drug Plan

SSA Publication No.05-10508, January 2010, ICN  470112 [View .pdfGet Accessible Adobe Acrobat Reader (En Español)
 

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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 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.

 

 

Contents

What is Extra Help with Medicare prescription drug plan costs?
What is the resource limit?
What does not count as a resource?
What is the income limit?
What does not count as income?
How do you apply?
What should you know about the application for Extra Help?
Tips for completing the application for Extra Help
Additional information for Medicare beneficiaries with disabilities
Additional information for American Indians and Alaska Natives
Additional information for family members, caregivers, and third parties
How can Social Security help you with the Medicare prescription drug plans?
How can state agencies help you with Medicare costs?
How do you join a Medicare prescription drug plan?
What factors should you consider when comparing your Medicare drug plan choices?
How can you get help to make a decision about enrolling in a specific prescription drug plan?
How do we make a decision on your application for Extra Help?
How can you appeal the final determination we made on your application for Extra Help?
How can you get more information?

 

 

 

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.

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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:

  • Real estate (other than your primary residence);

  • Bank accounts, including checking, savings, and certificates of deposit;

  • Stocks;

  • Bonds, including U.S. Savings Bonds;

  • Mutual funds;

  • Individual Retirement Accounts (IRAs); and

  • Cash at home or anywhere else.

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What does not count as a resource?

We do not count:

  • Your primary residence;

  • Your personal possessions;

  • Your vehicle(s);

  • Resources you could not easily convert to cash, such as jewelry or home furnishings;

  • Property you need for self-support, such as rental property or land you use to grow produce for home consumption;

  • Non-business property essential to your self-support;

  • Life insurance policies;

  • Burial spaces;

  • Interest earned on money you plan to use for burial expenses; and

  • Certain other money you are holding is not counted for nine months, such as:

—Retroactive Social Security or Supplemental Security Income (SSI) payments;

—Housing assistance;

—Federal income tax refunds and earned income tax credit advances;

—Economic recovery payments;

—Compensation you receive as a crime victim; and

—Relocation assistance from a state or local government.

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:

  • Support other family members who live with you;

  • Have earnings from work; or

  • Live in Alaska or Hawaii.

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What does not count as income?

Not all cash payments count as income. For example, we do not count:

  • Food stamp assistance;

  • Housing assistance;

  • Home energy assistance;

  • Medical treatment and drugs;

  • Disaster assistance;

  • Earned income tax credit payments;

  • Economic recovery payments;

  • Assistance from others to pay your household expenses;

  • Victim’s compensation payments; and

  • Scholarships and education grants.

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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).

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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:

  • Identify the things you own alone, 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.

The records you will need are:

  • Statements that show your account balances at banks, credit unions, or other financial institutions;

  • Investment statements;

  • Stock certificates;

  • Tax returns;

  • Pension award letters; and

  • Payroll slips.

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.

Resources Value
Bank accounts, including checking, savings, and certificates of deposit
Stocks, bonds, savings bonds, mutual funds, individual retirement accounts (IRAs), or other
Cash at home or anywhere else
Any real estate other than your home
 
Income Monthly Amount
Social Security Benefits $
Railroad Retirement benefits
Veterans benefits
Other pensions or annuities
Alimony
Net rental income
Workers' compensation
Other income (private or state disability payments)
 
Income Monthly Amount
Wages $
Net earnings from self-employment $

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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.

  • Computers read your application when you send it back to Social Security. Use only a pen with black ink to complete the application. Pens with ink of any color other than black cannot be read by the computer and could cause a delay in getting you an answer about your application for Extra Help.

  • Many questions on the application ask you to mark an “X” in a “Yes” or “No” box. Please remember that you cannot mark an “X” in both the “Yes” and “No” boxes.

  • Your Social Security number or Railroad Retirement Board number must be included on the application. In order to receive a quick response from us, please be sure you enter your name and number exactly as they appear on your Social Security card or Railroad Retirement Board card.

  • If you are single, widowed, divorced, or not living with your spouse, do not complete question 2 (marital information), and do not write in any boxes anywhere on the form that ask for information about your spouse.

  • 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. Do not complete question 15 if you want help from the Medicare Savings Programs.

  • Please send the entire application package back to us—not just the page that you signed. If you are unable to answer all the questions, send your application and we will help you complete it.

  • There is no need to send us anything other than your completed application. We do not need to see doctor bills, prescription lists, Internal Revenue Service (IRS) forms, or other documents.

  • Apply online at www.socialsecurity.gov/extrahelp or complete an original paper application. Please do not complete a photocopied, faxed, or downloaded copy of the application. Anything other than the online or original paper application could cause a delay in getting you an answer about your application for Extra Help. If you need a paper application, call Social Security at 1-800-772-1213 (TTY 1-800-325-0778) or visit a Social Security office. Social Security representatives are available to help you complete your application.

  • If relatives, neighbors, or friends want an application, have them visit Social Security online or call us to ask for an application. Please do not share your application with them.

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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. 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.

For example, Social Security will not count the following resources and income:

  • Certain distributions received by an Alaska Native from an Alaska Native Regional and Village Corporation;

  • Land held in trust by the United States for an individual Indian or Tribe;

  • Funds held in trust by the Secretary of the Interior for an Indian Tribe and distributed per capita to members of the Tribe;

  • Up to $2,000 per year received by an Indian that is derived from individual interests in trusts or restricted lands; and

  • Payments to members of specific Indian Tribes as provided by federal legislation.

You should contact Social Security for other resource and income exclusions.

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Additional information for family members, caregivers, and third parties

You 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.

 
 

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).

 
 

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?
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 time frame 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 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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