Extra Help with Medicare Prescription Drug Plan Cost Forms and Publications

Forms

Find Instructions for Completing the Application for Extra Help with Medicare Prescription Drug Plan Costs (SSA-1020-INST). The instructions are only guidelines and not to be used as applications.

These instructions are also available in the below languages...

Apply for Extra Help online (SSA-i1020) in English or Español, call Social Security at 1-800-772-1213 (TTY 1-800-325-0778) to apply over the phone or to request an original paper application (English or Español), or apply at your local Social Security office.

Appeal the decision we made about your eligibility for Extra Help by completing an Appeal of Determination for Extra Help with Medicare Prescription Drug Plan Costs (SSA-1021) in English or Español. Find Instructions for Completing the Appeal form in English or Español.

Ensure you still are eligible for Extra Help and receiving all the benefits you deserve by completing the Review of Your Eligibility for Extra Help (SSA-1026B) in English or Español.

Publications

Publications on Extra Help with Medicare prescription drug plan costs