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Changes in Qualifying for Extra Help in 2009

This is archive material for research purposes. Please see PDPFinder.com or MAFinder.com for current plans.
Medicare and Social Security are determining whether some people who qualify for extra help will continue to qualify in 2009. People affected by these changes will get information in the mail from Medicare or Social Security.

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People who no longer automatically qualify for extrahelp in 2009

Medicare and Social Security are working together to mail notices on grey paper to people who will no longer automatically qualify for extra help in 2009 (CMS Publication No. 11198). The notice will explain why a person no longer automatically qualifies and encourage them to complete an enclosed application for extra help. They can return the application to Social Security in the enclosed postage-paid envelope. People will get these notices by the end of September. People will no longer automatically qualify for extra help in 2009 because they no longer have one of the following:
  • Both Medicare and Medicaid (full-benefit dual-eligible)
  • A Medicare Savings Program (partial dual-eligible)
  • Both Medicare and Supplemental Security Income (SSI)

Partners should encourage these people to apply for the extra help with Social Security or their State Medical Assistance (Medicaid) office. Applying early is important so their extra help can be effective as early as January 1, 2009, the date that automatic eligibility ends. You can help them complete an application online at www.socialsecurity.gov, or you can help complete and mail the application they received in the mail. If a person’s situation changes and they again automatically qualify for extra help, Medicare will send them another notice on purple paper letting them know that they qualify.

People who continue to automatically qualify for extrahelp in 2009, but with a change in copayment level

Medicare is also mailing notices (on orange paper) to people who will continue to automatically qualify for extra help in 2009 but whose copayment levels will change as of January 1, 2009 (CMS Publication No. 11199). Medicare will mail these notices by early October to let people know what their new copayment level is as of January 1, 2009. The change in copayment level could result when a person with Medicare changes from one of the following categories to another:
  • Institutionalized with Medicare and Medicaid
  • Has Medicare and Medicaid
  • Has Medicare and Medicaid and a change in income level
  • Gets help from Medicaid paying Medicare Part B premiums (belongs to a Medicare Savings Program)
  • Gets Supplemental Security Income (SSI)

For example, if a person with both Medicare and Medicaid no longer resides in a nursing home, they may no longer qualify for a $0 copayment effective January 1, 2009.

Note:People with no changes who continue to automatically qualify for extra help as of January 1, 2009, won’t get a notice from Medicare.

For more information about Medicare’s notices

People who have questions about Medicare prescription drug coverage, or people who think they received a notice in error should call 1-800-MEDICARE (1-800 633-4227). TTY users should call 1-877-486-2048. They should let Medicare know they received a notice when they call.

People who applied and qualified for extra help

Social Security is reviewing the eligibility of selected people who applied and qualified for extra help to make sure they are still eligible and getting the correct amount of extra help in 2009. Social Security will mail these people a letter at the end of August with an "Income and Resources Summary" sheet telling them what Social Security’s records show for their income, resources, and household size. A cost of living increase in a person’s Social Security payments won’t be considered a change in their situation. People who get this letter must fill out the enclosed eligibility form called "Social Security Administration Review of Your Eligibility for Extra Help" (Form 1026-SM- REDE) and return the form within 30 days. If they don’t return the form, their extra help may end.
Social Security will review the eligibility review forms (1026-SM-REDE) and send letters explaining the decision. Social Security may decide any one of the following:
  • There is no change in their extra help.
  • There is an increase in the amount of their extra help.
  • There isa decrease in the amount of their extra help.
  • They no longer qualify for extra help.

Any change to the amount of extra help a person qualifies for could be effective asearly as January 2009, unless their marital status or marital living arrangements changed. Changes in marital status or marital living arrangements may result in changes to the amount of extra help in the following month.

Anyone who believes Social Security’s decision is incorrect has the right to appeal it. The decision letter will explain the person’s appeal rights.

Note: People who don’t get Social Security’s eligibility review form (1026-SM- REDE) will continue to qualify for extra help in 2009. They won’t get a separate notice from Social Security.

For more information about Social Security’s letter

  • Visit Social Security at www.socialsecurity.gov.
  • Call Social Security at 1-800-772-1213. TTY users should call 1-800-325-0778.
    Callers should let Social Security know they received a letter when they call.
Also see:

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  • When enrolling in a Medicare Advantage plan, you must continue to pay your Medicare Part B premium.
  • Medicare beneficiaries with higher incomes may be required to pay both a Medicare Part B and Medicare Part D Income Related Monthly Adjustment Amount (IRMAA). Read more on IRMAA.
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  • If you are enrolled in a Medicare plan with Part D prescription drug coverage, you may be eligible for financial Extra Help to assist with the payment of your prescription drug premiums and drug purchases. To see if you qualify for Extra Help, call: 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048, 24 hours a day/ 7 days a week or consult www.medicare.gov; the Social Security Office at 1-800-772-1213 between 7 a.m. and 7 p.m., Monday through Friday. TTY users should call, 1-800-325-0778; or your state Medicaid Office.
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  • Disclaimer for Dual Eligible (Medicare/Medicaid) Special Needs Plan (SNP): This plan is available to anyone who has both Medical Assistance from the State and Medicare. Premiums, co-pays, co-insurance, and deductibles may vary based on the level of Extra Help you receive. Please contact the plan for further details.
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  • Medicare MSA Plans do not cover prescription drugs. If you join a Medicare MSA Plan, you can also join any separate (stand-alone) Medicare Part D prescription drug plan
  • There are additional restrictions to join an MSA plan, and enrollment is generally for a full calendar year unless you meet certain exceptions. Those who disenroll during the calendar year will owe a portion of the account deposit back to the plan. Contact the plan provider for additional information.
  • Medicare beneficiaries may enroll through the CMS Medicare Online Enrollment Center located at www.medicare.gov.
  • Medicare beneficiaries can file a complaint with the Centers for Medicare & Medicaid Services by calling 1-800-MEDICARE 24 hours a day/7 days or using the medicare.gov site. Beneficiaries can appoint a representative by submitting CMS Form-1696.