Applying for Medicare’s Extra Help

By Patricia Barry

Copyright © 2018 by AARP. All rights reserved.

Perhaps your income and resources are limited but you’re not enrolled in one of the Medicare programs that qualify you for Extra Help automatically. In this case, you need to apply for Extra Help. You can apply at any time — when you first join Medicare, when you experience some change in your life that lowers your income, or if you’re already enrolled in Part D and have only just realized that Extra Help exists.

Applying involves filling out a form and sending it to the Social Security Administration (not Medicare), which then decides whether you qualify. Here are answers to questions people often ask about this process.

How can I obtain the form?

Use one of the following methods to get the application form:

  • Online: You can fill out and file the form online on the Social Security site. You can use this site to apply directly online, but only in English. You can print this form to fill out as a practice run before you make the proper online application, but you can’t mail in that hard copy in lieu of applying online. Full instructions are also on this site.
  • By phone: Call Social Security toll-free at 800-772-1213 (TTY 800-325-0778) and ask to have the form (in English or in Spanish) sent to you.
  • In person: You can get a form (and help filling it out if you need it) at your local Social Security office or State Health Insurance Assistance Program (SHIP) office.
  • By mail (without requesting it): Social Security sends an Extra Help application to virtually everyone who joins Medicare.

What if English isn’t my first language?

The application can be filled out only in English or Spanish, but detailed instructions are available in 15 languages besides English: Arabic, Armenian, Chinese, Farsi, French, Greek, Haitian-Creole, Italian, Korean, Polish, Portuguese, Russian, Spanish, Tagalog, and Vietnamese. You can find these directions online. Click on the name of the language you speak and then choose the Extra Help information. You can also get help from your SHIP by requesting to speak to a counselor who speaks your own first language.

What counts as income?

You should include on the form any of these that apply to you:

  • Pre-tax wages or earnings from self-employment
  • Social Security or railroad retirement benefits before deductions
  • Veterans’ benefits
  • Pensions and annuities
  • Workers’ compensation
  • Alimony
  • Net income from rental property

You can leave out

  • Cash or credit from a loan or a reverse mortgage
  • Federal income tax refunds and earned income tax credit payments
  • Victims’ compensation
  • Education grants and scholarships
  • Help from food stamps, a housing agency, an energy assistance program, or a public relocation program
  • Help from anyone who contributes toward your food, mortgage, rent, heating fuel, gas, electricity, water, and property taxes
  • Help paying for medical treatment and drugs
  • Disaster assistance

What counts as assets?

Assets, also called resources, are the value of certain things you own, mainly savings. You should include any of these that you have:

  • Bank accounts, including checking, savings, and certificates of deposit
  • Proceeds of a loan if saved beyond the month they’re received
  • Cash kept at home or anywhere else
  • Individual retirement accounts (IRAs) and 401(k)s
  • Stocks and bonds
  • Mutual funds
  • Real estate (other than your primary home)

You can leave out

  • Your primary home and the land it stands on
  • Your vehicle(s)
  • Personal possessions, including jewelry and furnishings
  • Property you need for self-support, such as land used to grow your own food
  • Burial plots
  • Life insurance policies

Social Security rules for Extra Help don’t prevent you from spending down or giving away some of your savings to reduce them below the asset limit. Only what you have during the month you apply is counted. However, keep in mind that gifts or spending down may affect your eligibility for other assistance programs — especially Medicaid, which has strict rules about this subject — if you find you need them within a few years.

What counts as “single” and “married” for income purposes?

Income levels are for either single people or married couples “who are living together,” regardless of whether they are opposite-sex or same-sex spouses. If you’re married and living with your spouse, you can both apply on the same form. If only one of you is applying, you still have to provide info on your spouse’s income and assets. You count as single if you’re married but living apart; your spouse is living permanently in a nursing home or another type of long-term care; or you have a domestic partner. However, if you’re in a common-law marriage, check with Social Security because being recognized as single or married may depend on the laws of your state.

What if I’m supporting other family members?

If any relatives — related to you by blood, marriage, or adoption — live with you and depend on you (or your spouse) for at least half of their support, be sure to answer the question on family size. Every extra person raises the income limits and increases your chances of qualifying for Extra Help.

Who can help me apply?

Many circumstances — like being sick or recently widowed, to name just two — may make you feel that dealing with this application on your own is beyond you at this time. In that case, don’t hesitate to get help. Many people can lend you a hand in applying:

  • Someone you know: Anybody can help you fill out the application or even apply on your behalf — a family member, a friend, a legal representative, a social worker, or anyone you choose to act for you.
  • Free, expert personal help: Counselors at your SHIP are trained to help people sort through their Part D options, including helping them apply for Extra Help.
  • Social Security: If you need help on how to answer specific questions, call Social Security at 800-772-1213 (TTY 800-325-0778) or visit your local Social Security office.
  • Community groups: You may be a member of a house of worship, senior center, or other community group that can assist you in filling out the form. If English isn’t your first language, an organization or group for people of your own nationality may be especially helpful in this regard.

How do I complete the application process?

You sign the form, which means that you’re legally declaring that all the information you’ve provided is true to the best of your knowledge. If you’re married and living together, your spouse must also sign it, even if he or she isn’t applying for Extra Help. If someone else signs for you, she should fill out the section of the form that asks for her name, address, and personal or professional relationship to you. Then you can submit the form by

  • Using the printed application form: Just put it in the pre-addressed envelope and mail it in. If the envelope is missing or lost, send the form to the Social Security Administration, Wilkes-Barre Data Operation Center, P.O. Box 1020, Wilkes-Barre, PA 18767.
  • Applying to Social Security online: The online instructions on the Social Security website tell you exactly what to do. You must answer all the questions before signing the form electronically and submitting it.
  • Applying on the BenefitsCheckUp website: You can apply for Extra Help by using the same online form. But this site also automatically screens your information and lets you know whether you qualify for any other benefits, such as assistance to pay for food, fuel, and shelter.

What happens after I apply?

So you’ve sent in your application and crossed your fingers, waiting for a decision. What’s next?

  • Social Security sends you a notice saying it has received your application and is processing it. If you don’t get this notice within a couple of weeks of applying, call Social Security at 800-772-1213 (TTY 800-325-0778) to check what’s going on.
  • You may hear from Social Security by phone or mail if it has additional questions. The agency will contact you if your application is incomplete or if some of your financial information doesn’t match other government records.
  • You may receive a pre-decisional notice saying your application is likely to be turned down. This document specifies what information on your application will cause you to be denied Extra Help — for example, that your income or assets are above the limits. If that information is wrong, this notice gives you the opportunity to correct it. You must do so within ten days of the date of the notice by calling or visiting your local Social Security office at the number or address given on the notice.
  • Social Security decides whether you’re eligible for Extra Help. You should hear within 60 days of Social Security’s receiving your application — maybe sooner. You’ll receive either a “Notice of Award” saying that you qualify for either full or partial Extra Help or a “Notice of Denial” saying that you don’t qualify. The denial notice contains full instructions on how to appeal the decision if you don’t agree with it.

What if Social Security turns me down?

You can always appeal Social Security’s decision if you don’t agree with it. You must appeal within 60 days of receiving a decision, in one of two ways:

  • Request a telephone hearing. Call your local Social Security office or the national number (800-772-1213 or TTY 800-325-0778) and ask to be sent an appeal request form. Fill it out and mail it in. You’ll receive a letter confirming the date of your hearing and the number to call. (You can ask for a conference call if you want someone else on the phone to help you.) The letter also explains how to send in any documents that support your case.
  • Ask for a case review. A case review means a Social Security agent reviews your application and any additional information you’ve sent in, but you can’t present your case in person.

After Social Security has reviewed your appeal, you receive a letter notifying you of the decision. If you win, you receive Extra Help backdated to the first day of the month in which you originally applied for the benefit. If you lose but still disagree with the decision, you can file a further appeal in a federal court within 60 days of receiving the letter.

If you’re denied Extra Help this time, don’t let it put you off reapplying, especially if your income or assets weren’t far over the limits. Keep in mind that the limits rise slightly each year, and even a small dip in your own finances may allow you to qualify through a new application.

If I qualify, how long does my Extra Help last?

In most cases, you continue to receive Extra Help until the end of the year, regardless of whether your financial circumstances have changed during the previous 12 months. But continuing to get Extra Help next year, starting January 1, depends on whether you’ve become financially better off this year. You can lose Extra Help (or receive a reduced benefit) next year if

  • Your income rises above the limits for Extra Help.
  • The value of your savings and other countable assets rises above the asset limits for Extra Help.
  • You cease to qualify for one of the programs that makes you automatically eligible for Extra Help — Medicaid, SSI, having your premiums paid by your state, or being in a Medicaid spend-down program.

Also, if any of the following marital events occur during the year, you’re expected to report them immediately so your eligibility for Extra Help can be reviewed:

  • Your spouse dies.
  • You and the spouse you’ve been living with start living apart, divorce, or have your marriage annulled.
  • You and your spouse start living together again after being apart.
  • You get married.

If any of these events happens to you, call Social Security (800-772-1213 or TTY 800-325-0778) to report it. You’re asked to complete a redetermination form on the phone, at your local Social Security office, or by mail. If you do so within 90 days of filing the report, Social Security decides whether to raise or reduce your Extra Help, end it, or leave it unchanged. Any change takes place the month following the month in which you filed the report. But if you don’t complete the required form within 90 days, your Extra Help is terminated.

How do I know whether my Extra Help will continue?

What will happen next year, and how you find out, depends on how you qualified for Extra Help in the first place, as follows:

  • If you qualified for Extra Help automatically: If nothing has changed, you don’t need to do anything. You’ll continue to get Extra Help. But if you no longer get help from Medicaid or SSI or have your premiums paid by your state, Medicare will send you a notice on gray paper saying that you no longer automatically qualify for Extra Help but can still apply for it.
  • If you qualified for Extra Help through a Medicaid medical spend-down program: If your medical expenses this year have been high enough to keep you on Medicaid at the end of the year, you’ll still get Extra Help next year. But if those expenses are no longer high enough to qualify you for Medicaid, you’ll probably get a letter saying that your Extra Help benefits stop as of January 1. The timing can make a difference here. If your name is still in the system in July, when Medicare compiles its list of people automatically eligible for Extra Help next year, you continue to receive benefits for all next year.
  • If you qualified for Extra Help by applying: In August or September, you may get a letter from Social Security asking whether your financial circumstances have changed. If so, you must fill out the form and return it within 30 days. If you don’t return it, your Extra Help ends on December 31. Social Security reviews your information and lets you know whether you still qualify for Extra Help next year and, if so, whether your benefits will change. For example, if your income has gone down, you may get lower co-pays next year — or, if it has risen above a certain level, you may get partial rather than full Extra Help. Any changes begin on January 1.