Section 1144 of the Social Security Act requires SSA to notify low-income Medicare beneficiaries about specific programs that may be able to assist them with their medical and prescription drug expenses. SSA is also required to identify those low-income Medicare beneficiaries to their States.

This section explains the outreach actions SSA is taking to inform Medicare beneficiaries about the Medicare Savings Programs (MSP) that help beneficiaries with their Medicare expenses and about the Extra Help (low-income subsidy) that may be available to beneficiaries for Medicare prescription drug coverage under Part D. The programs involved in this outreach effort include:

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  Qualified Medicare Beneficiaries (QMB);

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  Specified Low-Income Medicare Beneficiaries (SLMB);

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  Qualifying Individuals (QI);

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  Extra Help for Medicare Part D Beneficiaries; and

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  Qualified Disabled and Working Individuals (QDWI).

The QMB, SLMB, QI and QDWI programs are collectively known as the Medicare Savings Programs (MSP).

SSA discusses these programs in its publications, on www.socialsecurity.gov and during routine contacts with beneficiaries. Since 2002, section 1144 of the Social Security Act has increased SSA’s outreach efforts for the Medicare Savings Programs by requiring beneficiary notification and file sharing with the Medicaid State agencies.

Congress amended the Social Security Act to require SSA to use its records for outreach to potential MSP and Extra Help eligibles. Annually, SSA must identify potential MSP and Extra Help eligibles from our records, notify them about those programs and share the lists of potential eligibles with the State Medicaid agencies.

For handling beneficiary inquires resulting from receipt of the SSA-L441, SSA-L447, and SSA-L448 letters, N8NN agents follow the instructions in TC 23001.035.

If a beneficiary contacts the FO to ask about help paying for Medicare or requests help obtaining assistance with Medicare costs, provide the number of the local agency that administers Medicaid or the Medicare Savings Programs. You should also screen the beneficiary for potential eligibility to the Extra Help offered for Medicare Part D.

If a beneficiary alleges insufficient income, follow the guidance about SSI oral inquiries in SI 00601.025.

Note that inquiries from beneficiaries whose title II benefits preclude SSI and any federally administered State supplement are not protective filings for SSI, see GN 00903.100 on SSA’s referral services.

If you are contacted to take a Medicare Part A application by a beneficiary who already spoke with the Medicaid agency about possible QDWI eligibility, use Form CMS-18F5 (an exhibit of this form is available in OS 15060.085), check the record to see if the beneficiary is in the Initial Enrollment Period (IEP) and follow the instructions here:

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  If the beneficiary is in the IEP, schedule an application appointment as soon as possible.

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  If the beneficiary must enroll in the GEP or is in the GEP, schedule an application appointment between January and March.

The chart below shows the total number of SSA-L448 and SSA-L447 letters mailed in 2025. The chart also shows the total number of SSA-L441 letters mailed in 2024. The SSA-L441 is mailed in late November each year. All totals are shown by notice type (English/Spanish).

Letters to potential QMB, SLMB, and QIs are designated SSA-L447, SSA-L448, SSA-L447-SP, and SSA-L448-SP.

Letters to potential QDWIs are the SSA-L441 and SSA-L441-SP.

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  TC 23001.040 Comparison of QMB, SLMB, QI and QDWI

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  HI 00805.025 General Enrollment Period (GEP)

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  HI 00805.015 Initial Enrollment Period

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  HI 00801.172 Taking Premium HI Claims for the Working Disabled

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  HI 00801.170 Premium HI for the Working Disabled

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  SI 01715.005A.7 Qualified Disabled and Working Individuals

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  TC 23001.080 Qualified Disabled Working Individuals (QDDWI)

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  HI 00801.139 QMB Provisions

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  TC 23001.050 Qualified Medicare Beneficiaries (QMB)

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  TC 23001.070 Qualifying Individual 1 (QI1)

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  HI 00805.265 The Special Enrollment Period Definition

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  TC 23001.060 Specified Low-Income Medicare Beneficiaries (SLMB)

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  SI 00601.025 Protective Filing Oral Inquiry

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  GN 00903.100 Types of Referral Services SSA Provides

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  HI 03010.035 General Information about the Subsidy Application

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  TC 23001.035 Medicare Savings Program (QMB, SLMB, QI, QDWI) and Low-Income Medicare Beneficiaries Outreach