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  • Ssa-1021 2014

Get Ssa-1021 2014-2025

Code: If you recently changed your address, put an X here: If you would prefer that we contact someone else if we have additional questions, please provide the person’s name and a daytime phone number. Print First Name: Print Last Name: Phone Number: ( _____ ) ______ - ________ SECTION B If someone assisted you, place an X in the box that describes that person and provide the rest of the information requested below. Family Member Attorney Advocate Friend Agency Other Specify: Social .

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Extra Help is a program to help people with limited income and resources pay Medicare prescription drug program costs, like premiums, deductibles, and coinsurance. If you get Extra Help but you're not sure if you're paying the right amount, call your drug plan.

Is there a difference between the Medicare Part D Low Income Subsidy (LIS) and the Medicare Part D "Extra Help" Program? No. There is no difference between the Medicare Part D Low Income Subsidy (LIS) and the Medicare Part D "Extra Help" Program. We simply have two name for the same program.

To apply for the Medicare low-income subsidy, simply fill out an Application for Extra Help with Medicare Prescription Drug Plan Costs (SSA-1020) form with Social Security. You can apply and submit this form by: Applying online at www.socialsecurity.gov/extrahelp.

You should contact Social Security for other resource exclusions. What is the income limit? To qualify for Extra Help, your annual income must be limited to $19,140 for an individual or $25,860 for a married couple living together. Even if your annual income is higher, you may still be able to get some help.

Call 1-800-MEDICARE (TTY: 1-877-486-2048).

Interest earned on money you plan to use for burial expenses. Certain other money you are holding is not counted for nine months, such as: Retroactive Social Security or Supplemental Security Income (SSI) payments. Housing assistance.

Extra Help is a federal program that helps pay for some to most of the out-of-pocket costs of Medicare prescription drug coverage. It is also known as the Part D Low-Income Subsidy (LIS).

Eligible beneficiaries who have limited income may qualify for a government program that helps pay for Medicare Part D prescription drug costs. Medicare beneficiaries receiving the low-income subsidy (LIS) get assistance in paying for their Part D monthly premium, annual deductible, coinsurance, and copayments.

If you qualify for Medicaid, you automatically qualify for the Medicare Part D "Extra Help" program that may lower the cost of your prescription drugs.

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© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232
Form Packages
Adoption
Bankruptcy
Contractors
Divorce
Home Sales
Employment
Identity Theft
Incorporation
Landlord Tenant
Living Trust
Name Change
Personal Planning
Small Business
Wills & Estates
Packages A-Z
Form Categories
Affidavits
Bankruptcy
Bill of Sale
Corporate - LLC
Divorce
Employment
Identity Theft
Internet Technology
Landlord Tenant
Living Wills
Name Change
Power of Attorney
Real Estate
Small Estates
Wills
All Forms
Forms A-Z
Form Library
Customer Service
Terms of Service
DMCA Policy
About Us
Blog
Affiliates
Contact Us
Privacy Notice
Delete My Account
Site Map
All Forms
Search all Forms
Industries
Forms in Spanish
Localized Forms
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
airSlate workflows
DocHub
Instapage
Social Media
Call us now toll free:
1-877-389-0141
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232