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Understanding The Extra Help With Your Medicare Prescription Drug Plan

Social Security Administration - Medicare Part D
   - Understanding The Extra Help With Your Medicare Prescription Drug Plan



Table of Contents:

:: What is extra help with Medicare prescription drug plan costs?
:: What is the income limit?
:: What does not count as income?
:: What is the resource limit?
:: What does not count as a resource?
:: Income and Resources (Assets) Worksheet
:: How do you apply?
:: What should you know about the application for extra help?
:: Tips for completing the application for extra help
:: How do you answer question 5 about life insurance: face and cash values?
:: How do you answer question 11 about help with household expenses?
:: How do we make a decision on your claim?
:: How can you appeal the determination Social Security made on your application for extra help?
:: How can Social Security help you with the Medicare prescription drug plans?
:: How to get help to make a decision about enrolling in a specific prescription drug plan?
:: What factors should you consider when comparing your Medicare drug plan choices?
:: How do you join a Medicare prescription drug plan?
:: What should you do next?

Also see:
:: CMS Guide to LIS Mailings Summer and Fall 2014
:: What will the 2015 Part D Plans look like
:: Your Guide to Prescription Drug Coverage
:: How to Get Extra Help With Your Medicare Drug Plan Costs

This Website Q1Medicare.com also offers many tools to assist you in finding a Medicare Part D plan in your area.

:: Part D Plan Finder
:: Compare Changes Part D Plans from one year to the next
:: Plan Overview by State

Medicare Part D enrollment forms and support documents can be downloaded from any of the above search tools.
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Contacting Social Security

Visit the Social Security website

The Social Security website, www.socialsecurity.gov, is a valuable resource for information about all of Social Security’s programs. At Social Security’s website, you can:
  • Apply for extra help with Medicare prescription drug plan costs;
  • Apply for other Social Security benefits;
  • Find the address of your local Social Security office;
  • Request a Social Security Statement or a replacement Medicare card; and
  • Find copies of our publications.

Social Security’s 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. Social Security provide information by automated phone service 24 hours a day. If you are deaf or hard of hearing, you can call Social Security’s TTY number, 1-800-325-0778.

Social Security treat all calls confidentially. Social Security also want to make sure you receive accurate and courteous service. That is why Social Security have a second Social Security representative monitor some telephone calls.

(Source: Social Security Administration: Understanding The Extra Help With Your Medicare Prescription Drug Plan publication 10508. Additional examples and links from Q1Group LLC)
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Tips & Disclaimers
  • The Medicare Advantage and Medicare Part D prescription drug plan data on our site comes directly from Medicare and is subject to change.
  • Medicare has neither reviewed nor endorsed the information on our site.
  • We provide our Q1Medicare.com site for educational purposes and strive to present unbiased and accurate information. However, Q1Medicare is not intended as a substitute for your lawyer, doctor, healthcare provider, financial advisor, or pharmacist. For more information on your Medicare coverage, please be sure to seek legal, medical, pharmaceutical, or financial advice from a licensed professional or telephone Medicare at 1-800-633-4227.
  • Benefits, formulary, pharmacy network, provider network, premium and/or co-payments/co-insurance may change on January 1 of each year. Our PDP-Compare.com and MA-Compare.com provide highlights of annual plan benefit changes.
  • The benefit information provided is a brief summary, not a complete description of benefits. For more information contact the plan.
  • Limitations, copayments, and restrictions may apply.
  • We make every effort to show all available Medicare Part D or Medicare Advantage plans in your service area. However, since our data is provided by Medicare, it is possible that this may not be a complete listing of plans available in your service area. For a complete listing please contact 1-800-MEDICARE (TTY users should call 1-877-486-2048), 24 hours a day/7 days a week or consult www.medicare.gov.
  • When enrolling in a Medicare Advantage plan, you must continue to pay your Medicare Part B premium.
  • Medicare beneficiaries with higher incomes may be required to pay both a Medicare Part B and Medicare Part D Income Related Monthly Adjustment Amount (IRMAA). Read more on IRMAA.
  • Medicare Advantage plans that include prescription drug coverage (MAPDs) are considered Medicare Part D plans and members with higher incomes may be subject to the Medicare Part D Income Related Monthly Adjustment Amount (IRMAA), just as members in stand-alone Part D plans. In certain situations, you can appeal IRMAA.
  • You must be enrolled in both Medicare Part A and Part B to enroll in a Medicare Advantage plan. Members may enroll in a Medicare Advantage plan only during specific times of the year. Contact the Medicare plan for more information.
  • If you are enrolled in a Medicare plan with Part D prescription drug coverage, you may be eligible for financial Extra Help to assist with the payment of your prescription drug premiums and drug purchases. To see if you qualify for Extra Help, call: 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048, 24 hours a day/ 7 days a week or consult www.medicare.gov; the Social Security Office at 1-800-772-1213 between 7 a.m. and 7 p.m., Monday through Friday. TTY users should call, 1-800-325-0778; or your state Medicaid Office.
  • Medicare evaluates plans based on a 5-Star rating system. Star Ratings are calculated each year and may change from one year to the next.
  • A Medicare Advantage Private Fee-for-Service plan (PFFS) is not a Medicare supplement plan. Providers who do not contract with the plan are not required to see you except in an emergency.
  • Disclaimer for Institutional Special Needs Plan (SNP): This plan is available to anyone with Medicare who meets the Skilled Nursing Facility (SNF) level of care and resides in a nursing home.
  • Disclaimer for Dual Eligible (Medicare/Medicaid) Special Needs Plan (SNP): This plan is available to anyone who has both Medical Assistance from the State and Medicare. Premiums, co-pays, co-insurance, and deductibles may vary based on the level of Extra Help you receive. Please contact the plan for further details.
  • Disclaimer for Chronic Condition Special Needs Plan (SNP): This plan is available to anyone with Medicare who has been diagnosed with the plan specific Chronic Condition.
  • Medicare MSA Plans combine a high deductible Medicare Advantage Plan and a trust or custodial savings account (as defined and/or approved by the IRS). The plan deposits money from Medicare into the account. You can use this money to pay for your health care costs, but only Medicare-covered expenses count toward your deductible. The amount deposited is usually less than your deductible amount, so you generally have to pay out-of-pocket before your coverage begins.
  • Medicare MSA Plans do not cover prescription drugs. If you join a Medicare MSA Plan, you can also join any separate (stand-alone) Medicare Part D prescription drug plan
  • There are additional restrictions to join an MSA plan, and enrollment is generally for a full calendar year unless you meet certain exceptions. Those who disenroll during the calendar year will owe a portion of the account deposit back to the plan. Contact the plan provider for additional information.
  • Medicare beneficiaries may enroll through the CMS Medicare Online Enrollment Center located at www.medicare.gov.
  • Medicare beneficiaries can file a complaint with the Centers for Medicare & Medicaid Services by calling 1-800-MEDICARE 24 hours a day/7 days or using the medicare.gov site. Beneficiaries can appoint a representative by submitting CMS Form-1696.


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