The SHIP offers help with your Medicare questions. Please mail your application today. Carolyn W. Colvin Acting Commissioner Form SSA-1020B-OCR-SM-INST 01-2013 Recycle prior editions General Instructions for Completing the Application for Extra Help with Medicare If You Are Assisting Someone Else With This Application Answer the questions as if that person were completing the application. You must know that person s Do you have Medicare and Supplemental Security Income SSI or Medicare and Medicaid If the answer is YES do not complete this application because you automatically will get the Extra Help. Does your State Medicaid program pay your Medicare premiums because you belong to a Extra Help automatically and may not need to complete this application. How To Complete This Application Use BLACK INK only Keep your numbers letters and inside the boxes use only CAPITAL letters Do not add any handwritten comments on the application Do not use dollar signs when entering money amounts and C....
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How to fill out the SSA-1020B-OCR-SM-INST online
The SSA-1020B-OCR-SM-INST form is essential for individuals seeking Extra Help with Medicare prescription drug plan costs. This guide provides a step-by-step approach to filling out the form online, ensuring clarity and ease of understanding for all users.
Follow the steps to complete the SSA-1020B-OCR-SM-INST online successfully.
- Click the ‘Get Form’ button to access the form and open it in the online editor.
- Fill in the applicant’s name as it appears on their Social Security card, ensuring to use one box for each letter. Provide the applicant's Social Security number and date of birth in the designated fields.
- If applicable, enter the spouse's name, Social Security number, and date of birth. If not married or not living together, skip this step.
- Answer the question regarding savings and assets, marking 'YES' or 'NO' as appropriate for eligibility beyond the limits stated.
- For those answering 'NO' or 'NOT SURE', proceed to declare the value of all bank accounts, investments, and available cash. If none exist, mark the 'NONE' box.
- Indicate any other financial sources contributing to income, detailing the monthly amounts received and placing an 'X' in the 'NONE' box if not applicable.
- Complete each subsequent question by providing accurate financial details, ensuring to read instructions carefully for each regarding income and assets.
- Sign and date the application, providing contact information. If someone assisted in filling out the form, ensure to complete Section B with their details.
- Review all provided information for accuracy. Once confirmed, you can save your changes, download, print, or share the completed form as required.
Start filling out your SSA-1020B-OCR-SM-INST online today to ensure you receive the financial help you may need.
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