February 2024
Understanding the
Extra Help with Your
Medicare Prescription
Drug Plan
SSA.gov
What’s inside
What is Extra Help with Medicare prescription
drug plan costs? 1
Resources and income 1
Applying for Extra Help 3
Late enrollment penalty 4
If you’re an American Indian or Alaska Native 6
If you’re a family member, caregiver, or other
third party 7
How do I choose a specific plan? 7
Can state agencies help with Medicare costs? 9
Review of your eligibility 9
Appealing the decision 11
How can I get more information? 13
Contacting Us 13
1
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 may also be able to get Extra Help with
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 about $5,900 per year. Many people are eligible for
these big savings and don’t know it. To nd out, Social
Security will need to know the value of your savings,
investments, real estate (other than your home), and your
income. We need information about you and your spouse
if you are married and living together.
To help us determine if you are eligible for Extra Help, you
will need to le an Application for Extra Help with Medicare
Prescription Drug Plan Costs (Form SSA-1020).
Resources and income
What is the resource limit?
To be eligible for Extra Help, your resources must be
limited to $17,220 for a person or $34,360 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
certicates of deposit.
• Stocks.
• Bonds, including U.S. Savings Bonds.
• Mutual funds.
• Individual Retirement Accounts (IRAs).
• 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 couldn’t 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 expenses.
• Interest earned on money you plan to use for
burial expenses.
Certain other money you are holding is not counted
for 9 months, such as:
• Retroactive Social Security benets or Supplemental
Security Income (SSI) payments.
• Housing assistance.
• Tax advances and refunds related to earned income
tax credits and child tax credits.
• Compensation you receive as a crime victim.
• Relocation assistance from a state or
local government.
You should contact Social Security for other
resource exclusions.
What is the income limit?
To be eligible for Extra Help, your annual income must be
limited to $22,590 for a person or $30,660 for a married
couple living together. Even if your annual income is
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higher, you may still be able to get some help. Some
examples where your income may be higher and you can
still get Extra Help include if you or your spouse:
• Support other family members who live with you.
• Have earnings from work.
• Live in Alaska or Hawaii.
What doesn’t count as income?
Not all cash payments count as income. For example,
we don’t count:
• Supplemental Nutrition Assistance Program
(food stamps).
• Housing assistance.
• Home energy assistance.
• Medical treatment and drugs.
• Disaster assistance.
• Earned income tax credit payments.
• Assistance from others to pay your
household expenses.
• Victim’s compensation payments.
• Scholarships and education grants.
You should contact Social Security for other
income exclusions.
Applying for Extra Help
How do I apply?
Applying for Extra Help is easy. Just complete our
Application for Extra Help with Medicare Prescription Drug
Plan Costs (Form SSA-1020). Use one of these methods:
• Apply online at www.ssa.gov/medicare/part-d-extra-
help.
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• Call Social Security at 1-800-772-1213 (TTY
1-800-325-0778) to apply over the phone or to request
an application.
• Apply at your local Social Security ofce.
After you apply, we will review your application and let
you know if you are eligible for Extra Help. If so, you
can choose a Medicare prescription drug plan. 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 benets.
If you aren’t eligible for Extra Help, you can still enroll in a
Medicare prescription drug plan.
Late enrollment penalty
Medicare Prescription Drug Plan Penalty
If you don’t enroll in a Medicare drug plan when you’re
rst eligible, you may have to pay a late enrollment
penalty if you join a plan later. You’ll have to pay this
penalty for as long as you have Medicare prescription
drug coverage. However, you won’t pay a penalty
if you get Extra Help or other eligible prescription
drug plan coverage.
NOTE: The Medicare prescription drug plan late
enrollment penalty is different than the Medicare Part
B late enrollment penalty. If you don’t enroll in Part B
when you’re rst eligible for it, you may have to pay a
late enrollment penalty for as long as you have Part B
coverage. Also, you may have to wait to enroll, which will
delay Part B coverage.
For information about enrollment periods, visit
Medicare.gov or call 1-800-MEDICARE (1-800-633-4227;
TTY 1-877-486-2048).
5
Why should I apply online?
Our online application is secure and offers several
advantages. It takes you through the process step-by-step
with a series of self-help screens. The screens will tell you
what information you need to complete the application
and will guide you in answering the questions. You can
apply from any computer and at your own pace. You can
start and stop at any time during the process, so you
can leave the application and return later to update or
complete the information. We are careful to protect your
personal information.
What do I need to know?
Most of the questions on the application are about
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
information below 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:
• Review all your household income.
• Identify the things you own alone, with your spouse,
or with someone else, but do not include your home,
vehicles, burial plots, life insurance policies, or
personal possessions.
• Gather your records in advance to save time.
We need to know information about your (and your
spouse’s, if you are married and living together) resources
and income.
1. The dollar value of your resources for:
—Bank accounts, including checking, savings, and
certicates of deposit.
6
—Stocks, bonds, savings bonds, mutual funds,
individual retirement accounts (IRAs), or
other investments.
—Cash at home or anywhere else.
—Any real estate other than your home.
2. The monthly dollar amount of your income from:
—Social Security benets.
—Railroad Retirement benets.
—Veterans benets.
—Other pensions or annuities.
—Alimony.
—Net rental income.
—Workers’ compensation.
—Other income (e.g., unemployment, private or
state disability payments).
—Wages.
—Net earnings from self-employment.
We’ll compare your information with data available from
other government agencies to make sure the gures
match.
If you’re an American Indian or Alaska Native
Our “Resources and income” section provides a list of
what doesn’t count toward the resource and income limits
for the Extra Help benet. American Indians and Alaska
Natives may have other resources and income that
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.
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• Land held in trust by the United States for an American
Indian or a tribe.
• Funds held in trust by the Secretary of the Interior for a
tribe and distributed per capita to members of the tribe.
• Up to $2,000 per year received by an American Indian
that is derived from individual interests in trusts or
restricted lands.
• Payments to members of specic tribes as provided by
federal legislation.
You should contact Social Security for other resource and
income exclusions.
If you’re a family member, caregiver, or other
third party
You can help Medicare beneciaries 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 nd out if someone is eligible, we will
need to know the value of their savings, investments, real
estate (other than their home), as well as income. We
need information about the person you are helping and
their spouse, if they are married and living together. The
information in our “To prepare” section can help you with
the application.
You can help someone apply for Extra Help online by
visiting our website or calling our toll-free number to
request the Application for Extra Help with Medicare
Prescription Drug Plan Costs (Form SSA-1020). You also
can visit your local Social Security ofce for assistance.
How do I choose a specic plan?
Visit Medicare.gov, and use the following tools to help
you decide.
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Compare Medicare prescription drug plans — You
can nd and compare the prescription drug plans in
your state that meet your personal needs and enroll
in the prescription drug plan you select. You can enter
information about the specic medications you take and
get information to help you nd the plans in your state that
match your prescription drug needs.
To learn more about Medicare prescription drug plans and
special enrollment periods, please visit Medicare.gov or
call 1-800-MEDICARE.
What factors should I consider when comparing
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 always must
meet Medicare’s requirements.
Cost — Monthly premiums and your share of prescription
costs will vary depending on which plan you choose. If
you are eligible for Extra Help because you have limited
resources and income, you will get help with some or all
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 for you.
How do I join a Medicare prescription drug plan?
• 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 Medicare.gov using Medicare’s online
enrollment center.
• By paper application — Contact the company offering
the drug plan you choose and ask for an application.
9
After you ll out the form, mail or fax it back to
the company.
• By phone — Call the plan or call 1-800-MEDICARE,
and talk to a customer service representative.
Can state agencies help with Medicare costs?
When you le your application for Extra Help, you also
can start your application process for the Medicare
Savings Programs. These state programs provide help
with other Medicare costs. We 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 may also
pay for Medicare Part A (hospital insurance) premiums, if
any, and Part A and B deductibles and co-payments.
Medicaid or medical assistance is a joint federal and state
program that helps pay medical costs for some people
who have limited resources and income. Each state has
different rules about eligibility and applying for Medicaid.
Contact your state Medicaid ofce for more information.
Review of your eligibility
We may contact you periodically to review your status.
This review will ensure that you’re still eligible for the Extra
Help and still receiving all the benets you are eligible
for. Reviews are done every year, usually at the end of
August. If you aren’t selected for a review, there will be no
change in the amount of Extra Help you receive.
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How will Social Security contact me?
We’ll send you a form called Social Security
Administration Review of Your Eligibility for Extra Help
(SSA-1026). You’ll have 30 days to complete and return
this form. Any necessary adjustments to the Extra Help
will be effective in January of the following year. For
example, say we send you a review form in August
2024. If you return the review form within 30 days, any
necessary adjustment to your Extra Help will be effective
in January 2025.
What if I need help completing the form?
Family members, caregivers, and third parties can help
you complete the form. Social Security also can help
answer your questions. Just call us at 1-800-772-1213.
If you’re deaf or hard of hearing, please call our TTY
number at 1-800-325-0778. You may also visit your local
Social Security ofce for assistance.
What kind of adjustment will be made to my
Extra Help?
One of the following adjustments may be made:
• No change in the amount of Extra Help you receive.
• An increase in the amount of Extra Help you receive.
• A decrease in the amount of Extra Help you receive.
• Termination of your Extra Help.
What will happen if I don’t return the
review form?
Your Extra Help will stop in the following year.
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How will I know what decision Social Security
made on the review?
We will send you a letter explaining the decision we
made. If you believe the decision is incorrect, you have
the right to appeal it. The letter also will explain your
appeal rights.
Appealing the decision
What can I do if I disagree with the information
used to determine my eligibility?
We will send you a pre-decisional notice if the
information in our records shows you are ineligible for
Extra Help. If you don’t understand the notice, call us
at 1-800-772-1213, and we’ll explain it to you. If you
disagree with the information we have, call the number
above or visit your local Social Security ofce within 10
days of receiving the pre-decisional notice. You can then
give us the correct information.
We’ll send you a nal determination if you don’t provide
us any additional information within 10 days. It will
explain what you should do if you disagree with the nal
determination. We call this an appeal.
How can I appeal the nal determination made
on my application for Extra Help?
If you want to appeal the determination we made
about your eligibility for Extra Help with Medicare
prescription drug plan costs, complete the form, Appeal of
Determination for Extra Help with Medicare Prescription
Drug Plan Costs (Form SSA-1021). You will need to mail
the form to Wilkes-Barre Data Operations Center, P.O.
Box 1030, Wilkes-Barre, PA 18767-1030. You can also
visit your local Social Security ofce for help.
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What will happen when I appeal?
When you request the appeal, we’ll ask you to tell us why
you think our decision is wrong. Usually, we’ll set up an
appointment for a hearing to review your case with you by
telephone. To set up the hearing appointment, we’ll ask
you for two preferred times for us to call. Then, we’ll 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’ll decide your case by looking at the information we
have on le. We will also look at any new information you
give us, to be sure we make a proper decision. We call
this a hearing by case review.
Whether you request a hearing by telephone, or a hearing
by case review, we’ll send you another notice as soon as
we complete the necessary work on your claim.
Is there a timeframe 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
don’t appeal within 60 days, you may lose your right to
appeal, and the decision we made becomes nal. 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.
Can I get help to request an appeal?
You may choose to have someone help you with your
appeal or represent you. Your representative may be
a lawyer or other qualied person familiar with you and
the Social Security program. We will work with your
representative just as we would work with you. They can
act for you in most Social Security matters.
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What if I disagree with the decision?
If you disagree with the decision we make on your appeal,
you may le 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.
How can I get more information?
For more information about getting Extra Help with
your Medicare prescription drug plan costs, visit
www.ssa.gov/extrahelp or call us. Social Security
representatives are available to help you complete your
application. The sooner you apply, the sooner you will
begin receiving benets.
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 Medicare.gov
or call 1-800-MEDICARE. Your State Health Insurance
Counseling and Assistance Program (SHIP) also can help
answer your Medicare questions. You can nd your local
SHIP contact information in the back of your Medicare
handbook, online at Medicare.gov, or you can request it
when you call.
Contacting Us
There are several ways to contact us, such as online,
by phone, and in person. We’re here to answer your
questions and to serve you. For nearly 90 years, we have
helped secure today and tomorrow by providing benets
and nancial protection for millions of people throughout
their life’s journey.
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Visit our website
The most convenient way to conduct business with us is
online at www.ssa.gov. You can accomplish a lot.
• Apply for Extra Help with Medicare prescription drug
plan costs.
• Apply for most types of benets.
• Start or complete your request for an original or
replacement Social Security card.
• Find copies of our publications.
• Get answers to frequently asked questions.
When you create a personal my Social Security account,
you can do even more.
• Review your Social Security Statement.
• Verify your earnings.
• Get estimates of future benets.
• Print a benet verication letter.
• Change your direct deposit information (Social Security
beneciaries only).
• Get a replacement SSA-1099/1042S.
If you live outside the United States, visit
www.ssa.gov/foreign to see how you can access our
online services.
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Call us
If you cannot use our online services, we can help you by
phone when you call our National toll-free 800 Number.
We provide free interpreter services upon request.
You can call us at 1-800-772-1213 — or at our TTY
number, 1-800-325-0778, if you’re deaf or hard of hearing
— between 8:00 a.m. – 7:00 p.m., Monday through
Friday. For quicker access to a representative, try calling
early in the day (between 8 a.m. and 10 a.m. local time)
or later in the day. We are less busy later in the week
(Wednesday to Friday) and later in the month. We
also offer many automated telephone services, available
24 hours a day, so you may not need to speak with a
representative.
If you have documents we need to see, they must be
original or copies that are certied by the issuing agency.
Social Security Administration | Publication No. 05-10508
February 2024 (Recycle prior editions)
Understanding the Extra Help with Your Medicare Prescription Drug Plan
Produced and published at U.S. taxpayer expense
