Tips for Completing The Application For Extra Help
With Medicare Prescription Drug Plan Costs

Filing for Extra Help with your Medicare prescription drug plan costs? Here are some tips to help you complete Social Security’s Application for Extra Help with Medicare Prescription Drug Plan Costs (Form SSA-1020). Following these tips will help us process your application as quickly as possible.

• Computers scan your application when you send it back to Social Security. Use only a pen with black ink. 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.

• Complete the online application at www.socialsecurity.gov/extrahelp

• If you cannot file online you can request an original paper application, which you can get from any Social Security office or by calling us at 1-800-772-1213 (TTY 1-800-325-0778). 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 at www.socialsecurity.gov/extrahelp or call 1-800-772-1213 (TTY 1-800-325-0778) and ask for an application. Please do not share your application with them.

Remember to consider resources and income

To qualify for Extra Help:

• Your resources must be limited to $12,510 for an individual ($25,010 for a married couple living together). Resources include such things as bank accounts, stocks and bonds. We do not count your home and car as resources; and
   
• Your annual income must be limited to $16,245 for an individual ($21,855 for a married couple living together).
  
  Even if your annual income is higher, you still may be able to get some help with your monthly premiums, annual deductibles and prescription co-payments. Some examples where your income may be higher include if you or your spouse:
  
  
  • Support other family members who live with you;
  • Have earnings from work; or
  • Live in Alaska or Hawaii.