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Social Security Administration (SSA) Data for
Extra Help with Medicare Prescription Drug Plan Costs

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This dataset contains data for fiscal years 2016 onward and is currently available in the following formats:
CSV | XLSX

This dataset contains data for fiscal years 2010 - 2015 and is currently available in the following formats:
CSV | XLSX

Background

The SSA takes Medicare applications and provides Medicare information to the American public. The agency has a specific role in the Medicare Prescription Drug Program (Part D). Social Security takes and decides applications for Extra Help with Medicare Prescription Drug Plan Costs, a provision to subsidize costs for Part D prescription drug plans for qualifying low income applicants. Other individuals automatically qualify (or are "deemed") for Extra Help with Medicare Prescription Drug plan costs because they also have Medicaid or receive Supplemental Security Income (SSI) benefits.

This documentation describes the publicly available data about Social Security determinations of eligibility for Extra Help with Medicare Prescription Drug Plan Costs. The dataset includes annual data at the state level of SSA Extra Help decisions. Specific data elements are counts of Extra Help decisions made, counts of applicants found eligible for Extra Help, and a percentage of Extra Help decisions found eligible. The dataset does not include counts of individuals who automatically qualify (or are "deemed") for Extra Help or individuals who applied for Extra Help through a State Medicaid agency.

Dataset Index

Agency Program Description

Medicare is our country’s health insurance program for people age 65 or older. Certain people younger than age 65 can qualify for Medicare, too, including those who have disabilities, permanent kidney failure, or amyotrophic lateral sclerosis (Lou Gehrig’s disease). The program helps with the cost of health care, but does not cover all medical expenses or the cost of most long-term care.

Medicare is financed by a portion of the payroll taxes paid by workers and their employers. It also is financed in part by monthly premiums deducted from Social Security checks.

The Centers for Medicare & Medicaid Services in the Department of Health and Human Services is the agency in charge of the Medicare program, but you apply for Medicare at Social Security. SSA can give you general information about the Medicare program. For complete information about Medicare go to CMS.gov.

Medicare has four parts:

  • Hospital Insurance (Part A) helps pay for inpatient care in a hospital or skilled nursing facility (following a hospital stay), some home health care, and hospice care.
  • Medical Insurance (Part B) helps pay for doctor services and many other medical services and supplies that are not covered by hospital insurance.
  • Medicare Advantage (Part C) plans are available in many areas. People with Parts A and B can choose to receive all of their health care services through a provider organization under Part C.
  • Prescription Drug Coverage (Part D) helps pay for medications doctors prescribe for treatment.

Medicare beneficiaries can qualify for Extra Help with their Medicare prescription drug plan (Part D) costs. To qualify for the Extra Help, a person must be receiving Medicare, have limited resources and income, and reside in one of the 50 States or the District of Columbia. Medicare beneficiaries can automatically qualify for Extra Help if they also receive any type of Medicaid assistance from their State or get Supplemental Security Income (SSI) benefits. Medicare beneficiaries can apply for Extra Help online by completing the Social Security Application for Extra Help with Medicare Prescription Drug Plan Costs (SSA-1020). To apply, go to What help can I receive, call Social Security at 1-800-772-1213 (TTY 1-800-325-0778) to apply over the phone or request an application, or apply at your local Social Security office.

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Dataset Description

This dataset provides annual data at the national and state levels of SSA decisions for Extra Help with Medicare Prescription Drug Plan Costs (Part D). The percentage of eligible applications is derived by dividing the number of individuals found eligible for Extra Help With Medicare Prescription Drug Plan Costs by the total number of decisions made by SSA on Extra Help With Medicare Prescription Drug Plan Costs.

(NOTE: This dataset does not include individuals who applied for Extra Help through a State Medicaid agency or who automatically qualified for Extra Help because they receive Medicaid assistance or SSI benefits.)

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Data Collection Description

The information for the dataset is a result of information keyed into web applications either by the public/applicant or by an agency employee. The source of the dataset is the Social Security Unified Measurement System (SUMS) Counts Data Warehouse. The data is updated daily with the most current SUMS Workload data from the Medicare Operational Data Store.

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Data Dictionary

Fiscal Year: The 12-month period from October 1st through September 30th. Reporting year indicates the fiscal year the data was produced. Reporting years are administratively set reporting periods and do not necessarily correspond exactly to calendar months.

State: The state (or one other location which is the District of Columbia and is shown in the table as DC) provided as the applicant’s address. Locations other than the fifty states and DC are shown as "No Zip Available".

Decisions Made: indicates the number of decisions made on Extra Help With Medicare Prescription Drug Plan Cost applications by the Social Security Administration.

Eligible: The number of applicants found eligible after submitting an application for Extra Help With Medicare Prescription Drug Plan Cost.

Percentage Eligible: Eligible divided by Decisions Made expressed as a percentage. This is the percentage of applicants eligible for Extra Help With Medicare Prescription Drug Plan Costs after filing an application with Social Security.

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