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Application For Help With Medicare Prescription Drug Plan Costs - Social Security Administration

What You Need To Complete The Application For

Help With Medicare Prescription Drug Plan Costs

ocial Security and the Centers for

Documents that will help you

Medicare & Medicaid Services are work-

prepare in advance include:

ing together to get you extra help with your

prescription drug costs. To determine if you

• Statements that show your account bal-

could be eligible for this extra help, Social

ances at banks, credit unions or other

Security will need to know your income

financial institutions;

and the value of your savings, investments

• Investment statements;

and real estate (other than your home). You

• Life insurance policy statements;

may qualify for extra help if you have:

• Stock certificates;

• Limited income (below $14,355 for an

• Tax returns;

individual or $19,245 for a married cou-

ple living together). Even if your annual

• Pension award letters; and

income is higher, you still may be able to

• Payroll slips.

get some help with your monthly premi-

ums, annual deductibles and prescription

How you can get more information

co-payments. Some examples where your

income may be higher include if you or

If you need an application form, contact

your spouse:

Social Security and ask for the Application

for Help with Medicare Prescription Drug

—Support other family members who

Plan Costs (SSA-1020).

live with you;

Beginning July 1, 2005, you also will

—Have earnings from work; or

be able to apply online at

—Live in Alaska or Hawaii; and

• Limited resources (below $10,000 for an

To learn more about the Medicare

individual or $20,000 for a married cou-

prescription drug plan, call

ple living together). These resource lim-

1-800-MEDICARE (1-800-633-4227)

its can be slightly higher (an additional

or visit

$1,500 per person) if you will use some

of your money for burial expenses.

Please continue to the opposite side of the

page to complete the worksheet.

What you need to know

Identify the things you own by yourself,

with your spouse or with someone else, but

do not include your home, vehicles, burial

plots or personal possessions.

Review all your income.

Gather your records in advance to save

time.

Remember that this worksheet is not an

application. This worksheet can assist you

in completing the actual application for

extra help.

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What You Need To Complete The Application For

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Help With Medicare Prescription Drug Plan Costs

Application For Help With Medicare Prescription Drug Plan Costs - Social Security Administration

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