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What if my application for extra help is denied?

You have the right to appeal the decision. If you applied with Social Security, they will give you a hearing by telephone unless you choose a case review. Either way, Social Security will review those parts of the decision which you believe are wrong and will look at any new facts you provide. Social Security may also review those parts which you believe are correct. The person who will decide your case will be someone who wasn’t involved in the first decision.

To request an appeal, call Social Security at 1-800-772-1213. You can also get a copy of the form SSA-1021, "Appeal of Determination for Help with Medicare Prescription Drug Costs" by visiting www.socialsecurity.gov on the web.

If you want to file an appeal, remember the following:
  • You have 60 days to ask for an appeal.
  • The 60 days start the day after you get a letter from Social Security denying your application. Social Security will assume you got the letter 5 days after the date on it unless you show them that you didn’t get it within the 5-day period.
  • You can have a lawyer, friend, or someone else help you. Call Social Security at 1-800-772-1213 for a list of groups that can help you with your appeal. To find your local Social Security office, visit www.socialsecurity.gov on the web. Select "Find a Social Security office."


If you apply for extra help with your state, your decision letter should include appeal rights and procedures. Call your State Medical Assistance (Medicaid) office for information on the appeals process for your state.



(Primary Source: Centers for Medicare and Medicaid Services - Your Guide to Medicare Prescription Drug Coverage 2008. This content may have been enhanced by Q1Group LLC to include further examples, explanations, and links.)


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