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Additional information for family members, caregivers and third parties

 You can help someone you care about apply for extra help with their Medicare prescription drug plan costs. Anyone who has Medicare can get Medicare Prescription Drug coverage. Extra help is available for people with limited income and resources and will pay for part of the monthly premiums, annual deductibles and prescription copayments related to their plan. The extra help could be worth up to $4,000 per year. Many people with limited income and resources qualify for these big savings and don’t even know it. To find out if someone is eligible, Social Security will need to know their income and the value of their savings, investments and real estate (other than their home). If they are married and living with their spouse, we will need this information for both of them.

If you assist someone with the application, you must answer the questions as if that person were completing the application.
Social Security can give you an application for extra help, so you can help a Medicare beneficiary apply. The worksheet can assist you with the application, but the worksheet is not an application. (Click here to open the Income and Resources Worksheet in a new window.)

Ask whoever you are helping to:
  • Identify the things they own alone, with their spouse or with someone else. They should not include their home, vehicles, burial plots, life insurance or personal possessions.
  • Review all their income.
  • Gather their records in advance to save time.

Documents that will help you prepare in advance for anyone you are helping:
  • Statements that show their account balances at banks, credit unions or other financial institutions;
  • Investment statements;
  • Stock certificates;
  • Tax returns;
  • Pension award letters; and
  • Payroll slips.




State agencies also may be able to help with Medicare costs

State medical assistance (Medicaid) offices offer a Medicare Savings Program. The Medicare Savings Program also helps people with limited income and resources pay for their Medicare expenses. If the person you are helping is paying a premium for Medicare Part A, the Medicare Savings Program may pay it for them. The help they get from the Medicare Savings Program can save them more than $1,100 a year. This assistance is in addition to the extra help.

If you think they might be able to get help with Medicare costs from their state, or if you are not sure, call their state medical assistance (Medicaid) office or 1-800-MEDICARE (1-800-633-4227; TTY 1-877-486-2048).




What you should do next

You can help someone apply for extra help online at www.socialsecurity.gov. To help them apply by phone or get an application, call Social Security at 1-800-772-1213 (TTY 1-800-325-0778) and ask for the Application for Help with Medicare Prescription Drug Plan Costs (SSA-1020).

To learn more about the Medicare prescription drug plans visit PDP-Finder.com. To learn more about special enrollment periods, visit What are the Medicare Part D Special Enrollment Periods (SEP)?




Also see:

(Source: Social Security Administration: Understanding The Extra Help With Your Medicare Prescription Drug Plan publication 10508, January 2011. Additional examples and links from Q1Group LLC)


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Tips & Disclaimers
  • Q1Medicare®, Q1Rx®, and Q1Group® are registered Service Marks of Q1Group LLC and may not be used in any advertising, publicity, or for commercial purposes without the express authorization of Q1Group.
  • The Medicare Advantage and Medicare Part D prescription drug plan data on our site comes directly from Medicare and is subject to change.
  • Medicare has neither reviewed nor endorsed the information on our site.
  • We provide our Q1Medicare.com site for educational purposes and strive to present unbiased and accurate information. However, Q1Medicare is not intended as a substitute for your lawyer, doctor, healthcare provider, financial advisor, or pharmacist. For more information on your Medicare coverage, please be sure to seek legal, medical, pharmaceutical, or financial advice from a licensed professional or telephone Medicare at 1-800-633-4227.
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  • The benefit information provided is a brief summary, not a complete description of benefits. For more information contact the plan.
  • Limitations, copayments, and restrictions may apply.
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    "We do not offer every plan available in your area. Any information we provide is limited to those plans we do offer in your area. Please contact Medicare.gov or 1-800-MEDICARE to get information on all of your options."
  • 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.
  • Medicare Advantage plans that include prescription drug coverage (MAPDs) are considered Medicare Part D plans and members with higher incomes may be subject to the Medicare Part D Income Related Monthly Adjustment Amount (IRMAA), just as members in stand-alone Part D plans. In certain situations, you can appeal IRMAA.
  • You must be enrolled in both Medicare Part A and Part B to enroll in a Medicare Advantage plan. Members may enroll in a Medicare Advantage plan only during specific times of the year. Contact the Medicare plan for more information.
  • 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.
  • Medicare evaluates plans based on a 5-Star rating system. Star Ratings are calculated each year and may change from one year to the next.
  • A Medicare Advantage Private Fee-for-Service plan (PFFS) is not a Medicare supplement plan. Providers who do not contract with the plan are not required to see you except in an emergency.
  • Disclaimer for Institutional Special Needs Plan (SNP): This plan is available to anyone with Medicare who meets the Skilled Nursing Facility (SNF) level of care and resides in a nursing home.
  • 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.
  • Disclaimer for Chronic Condition Special Needs Plan (SNP): This plan is available to anyone with Medicare who has been diagnosed with the plan specific Chronic Condition.
  • Medicare MSA Plans combine a high deductible Medicare Advantage Plan and a trust or custodial savings account (as defined and/or approved by the IRS). The plan deposits money from Medicare into the account. You can use this money to pay for your health care costs, but only Medicare-covered expenses count toward your deductible. The amount deposited is usually less than your deductible amount, so you generally have to pay out-of-pocket before your coverage begins.
  • 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.
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