2017

Understanding the Extra 

Help With Your Medicare 

Prescription Drug Plan

SocialSecurity.gov

What’s inside

What is Extra Help with Medicare prescription 

drug plan costs? 1

Resources and income 1

Applying for Extra Help 4

Late Enrollment Penalty 4

If you’re an American Indian or Alaska Native 8

If you’re a family member, caregiver, or other 

third party 8

How do I choose a specific plan? 9

Can state agencies help with Medicare costs? 10

Appealing the decision 11

How can I get more information? 13

Contacting Social Security 14

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 also may 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 $4,000 per year. Many people qualify for 

these big savings and don’t even know it. To find out if 

you qualify, 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 Social Security determine if you are eligible 

for Extra Help, you will need to file an Application for 

Extra Help with Medicare Prescription Drug Plan Costs 

(Form SSA-1020).

Resources and income

What is the resource limit?

To qualify for Extra Help, your resources must be limited 

to $13,820 for an individual or $27,600 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 

certificates of deposit

• Stocks

• Bonds, including U.S. Savings Bonds
2

• Mutual funds

• Individual Retirement Accounts (IRAs)

• Cash at home or anywhere else

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; and

• Certain other money you are holding is not counted for 

nine months, such as:

—Retroactive Social Security 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; and

—Relocation assistance from a state or local 

government.

You should contact Social Security for other 

resource exclusions.
3

What is the income limit?

To qualify for Extra Help, your annual income must be 

limited to $18,090 for an individual or $24,360 for a 

married couple living together. Even if your annual income 

is 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; or

• 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; and

• Scholarships and education grants.

You should contact Social Security for other 

income exclusions.
4

Applying for Extra Help

How do I apply?

Applying for Extra Help is easy. Just complete Social 

Security’s Application for Extra Help with Medicare 

Prescription Drug Plan Costs (Form SSA-1020). 

Here’s how:

• Apply online at www.socialsecurity.gov/extrahelp;

• Call Social Security at 1-800-772-1213 (TTY 

1-800-325-0778) to apply over the phone or to request 

an application; or

• Apply at your local Social Security office.

After you apply, Social Security will review your 

application and send a letter to you to let you know if you 

qualify for Extra Help. After you qualify, 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 benefits.

If you aren’t eligible for Extra Help, you still may be able to 

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 

first eligible, you may 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.
5

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 first 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 

www.medicare.gov or call 1-800-MEDICARE

(1-800-633-4227; TTY 1-877-486-2048).

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 fully. 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 any of the required 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 worksheet 

on the next page 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.
6

To prepare:

• 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;

• Review all your income; and

• Gather your records in advance to save time.

The records you’ll need are:

• Statements that show your account balances at banks, 

credit unions, or other financial institutions;

• Investment statements;

• Stock certificates;

• Tax returns;

• Pension award letters; and

• Payroll slips.

We won’t ask for proof to support the information you 

provide, but we’ll match your information with data 

available from other government agencies to make sure it 

is correct.

We need to know information about your (and your 

spouse’s, if you are married and living together) resources 

and income.
7

Resources Value

Bank accounts, including checking, savings, and 

certificates of deposit $

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 $

Income Monthly 

Amount

Social Security benefits $

Railroad Retirement benefits $

Veterans benefits $

Other pensions or annuities $

Alimony $

Net rental income $

Workers’ compensation $

Other income (e.g., unemployment, private or 

state disability payments) $

Income Annual 

Amount

Wages $

Net earnings from self-employment $
8

If you’re an American Indian or Alaska Native

Pages 5 and 6 provide a list of resources and income that 

don’t count toward the resource and income limits for the 

Extra Help benefit. 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;

• Land held in trust by the United States for an individual 

Indian or tribe;

• Funds held in trust by the Secretary of the Interior for 

an Indian 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; and

• Payments to members of specific Indian 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 beneficiaries 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 find out if someone is eligible, Social 

Security will need to know the value of his or her savings, 

investments, real estate (other than the home), as well 

as income. We need information about whomever you 
9

are helping and his or her spouse, if they are married and 

living together. The information on page 8, and worksheet 

on page 9, 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 office for assistance.

How do I choose a specific plan?

Visit www.medicare.gov, and use the following tools to 

help you decide.

• Compare Medicare prescription drug plans — You 

can find and compare the prescription drug plans in 

your state that meet your personal needs and enroll in 

the prescription drug plan you select; and

• Formulary Finder — You can enter information about 

the specific medications you take and get information 

to help you find 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 

www.medicare.gov or call 1-800-MEDICARE.
10

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 qualify for Extra Help because you have limited 

resources and income, you will get help with some or all 

of 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 

www.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. 

After you fill out the form, mail or fax it back to the 

company; or

• 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 file 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. Social Security will send 
11

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 also may 

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 office for more information.

Appealing the decision

What can I do if I disagree with the information 

used to determine my eligibility?

Social Security 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 office within 10 

days of receiving the pre-decisional notice, and give us 

the correct information.

We’ll send you a final 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 final 

determination. We call this an appeal.
12

How can I appeal the final determination made 

on my application for Extra Help?

If you want to appeal the determination Social Security 

made about your eligibility for Extra Help with Medicare 

prescription drug plan costs, visit our website, or call us 

and ask for an Appeal of Determination for Extra Help with 

Medicare Prescription Drug Plan Costs (Form SSA-1021). 

You can mail the request to Wilkes-Barre Data Operations 

Center, P.O. Box 1030, Wilkes-Barre, PA 18767-1030. 

You can also visit your local Social Security office.

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 file, and 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 final. 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.
13

Can I get help to request an appeal?

You may choose to have someone help you with your 

appeal or to represent you. Your representative may 

be a lawyer or other qualified person familiar with you 

and the Social Security program. We will work with your 

representative just as we would work with you. He or she 

can act for you in most Social Security matters.

What if I disagree with the decision?

If you disagree with the decision Social Security makes 

on your appeal, you may file 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.socialsecurity.gov/extrahelp, or call Social 

Security. Social Security representatives are available 

to help you complete your application. The sooner you 

apply, the sooner you will begin receiving benefits.

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 www.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 find your local 

SHIP contact information in the back of your Medicare 

handbook, online at www.medicare.gov, or you can 

request it when you call.
14

Contacting Social Security

There are several ways to contact Social Security, 

including online, by phone, and in person. We’re here to 

answer your questions and to serve you. For more than 

80 years, Social Security has helped secure today and 

tomorrow by providing benefits and financial protection for 

millions of people throughout their life’s journey.

Visit our website

The most convenient way to conduct Social Security 

business from anywhere at any time, is to visit 

www.socialsecurity.gov. There, you can:

• Create a my Social Security account to review your 

Social Security Statement, verify your earnings, print 

a benefit verification letter, change your direct deposit 

information, request a replacement Medicare card, get 

a replacement 1099/1042S, and more;

• Apply for Extra Help with Medicare prescription drug 

plan costs;

• Apply for retirement, disability, and Medicare benefits;

• Find copies of our publications;

• Get answers to frequently asked questions; and

• So much more!

Call us

If you don’t have access to the internet, we offer many 

automated services by telephone, 24 hours a day, 7 days 

a week. Call us toll-free at 1-800-772-1213 or at our TTY 

number, 1-800-325-0778, if you’re deaf or hard of hearing.

If you need to speak to a person, we can answer your calls 

from 7 a.m. to 7 p.m., Monday through Friday. We ask for 

your patience during busy periods since you may experience 

higher than usual rate of busy signals and longer hold times 

to speak to us. We look forward to serving you.
15

Notes
Social Security Administration | Publication No. 05-10508

ICN 470112 | Unit of Issue — Package of 25

January 2017 (Recycle prior editions)

Understanding the Extra Help With Your Medicare Prescription Drug Plan

Produced and published at U.S. taxpayer expense

Printed on recycled paper