TN 43 (05-23)

HI 00815.025 SSA Outreach to Low-Income Medicare Beneficiaries – Extra Help and Medicare Savings Programs


Section 1144 of the Social Security Act as amended December 8, 2003.

A. SSA’s outreach notice requirements

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:

  • Qualified Medicare Beneficiaries (QMB);

  • Specified Low-Income Medicare Beneficiaries (SLMB);

  • Qualifying Individuals (QI);

  • Extra Help for Medicare Part D Beneficiaries; and

  • Qualified Disabled and Working Individuals (QDWI).

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

B. Background on SSA’s outreach program

SSA discusses these programs in its publications, on 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.

NOTE: An Application for Extra Help with Medicare Prescription Drug Plan Costs (SSA-1020) starts the application process for the Medicare Savings Programs (MSP) unless the beneficiary objects. SSA transmits data from the Extra Help application decision to the appropriate state Medicaid agency to begin the MSP process. For more detailed information about the MSP, see HI 00815.023.

C. Process for mailing outreach letters

1. Informing beneficiaries

Systems uses the Master Beneficiary Record, the Supplemental Security

Record, the Medicare Application Processing System (MAPS), and files from other Federal agencies to produce files of Medicare beneficiaries who appear to meet criteria for an outreach letter. Vendors use those files to send outreach letters to potential eligibles. Generally, beginning in May through June of each year, SSA mails outreach letters to potential QMBs, SLMBs, QIs and prescription drug subsidy (Extra Help) eligibles; however, letters to QDWIs will be mailed at the end of November.

The letters to potential QMBs, SLMBs, QIs who have not filed for a prescription drug subsidy (Extra Help) include information about the Extra Help program. Field offices (FO) will assist beneficiaries when needed to file an application for Extra Help, the SSA-1020, or take an application through MAPS.

The letters are:

  • SSA-L447 - Countable income appears to be less than 135% of poverty and the beneficiary has Extra Help but does not have MSP.

  • SSA-L448 - Countable income appears to qualify the beneficiary for Extra Help and MSP, but the beneficiary has neither.

  • SSA-L441 - Former Disability Insurance beneficiaries who lost their free Medicare Part A because of work and do not have Medicaid according to SSA records.

Letters to QDWIs (the SSA-L441) arrive shortly before the Medicare General Enrollment Period (GEP) so that potentially eligible individuals will contact their local Medicaid office first then contact SSA second when appropriate to schedule an application. (For more information about Medicare enrollment, eligibility, and coverage for the working disabled, see HI 00801.170).

The outreach letters ask beneficiaries to contact their State or local medical assistance (Medicaid) office, social service or welfare office listed in the government pages of the phone book about MSP and contact SSA about Extra Help.

REMINDER: Since an application for Extra Help also serves as an application for MSP, there is no reason for us to provide MSP outreach letters to Extra Help applicants.

2. Informing States

The Office of Systems also transmits files electronically to each State sorted by ZIP code and social security number about the same time that the mass mailing occurs. SSA lets the State Medicaid agencies know how many and which beneficiaries will receive an outreach letter.

D. National 800 Number Network (N8NN) and FO procedures for handling beneficiary inquiries

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

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 in

SI 00601.025 about SSI oral inquiries. 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 steps below:

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

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

NOTE: Beneficiaries can also enroll during a Special Enrollment Period (SEP). For additional information regarding SEP, see HI 00805.265.

E. Actual number of letters mailed


The chart below shows the total number of SSA-L448 and SSA-L447 letters mailed in 2023. The chart also shows the total number of SSA-L441 letters mailed in 2022. The SSA-L441 is mailed in late November each year. All totals are shown by notice type (English/Spanish).


Number of SSA-L448 Letters

Number of SSA-L447 Letters

Number of SSA-L441 Letters





F. References



TC 23001.040

Comparison of QMB, SLMB, QI and QDWI

HI 00805.025

General Enrollment Period (GEP)

HI 00805.015

Initial Enrollment Period

HI 00801.172

Taking Premium HI Claims for the Working Disabled

HI 00801.170

SI 01715.005A.7.

TC 23001.080

Premium HI for the Working Disabled

Qualified Disabled and Working Individuals

Qualified Disabled Working Individuals (QDDWI)

HI 00801.139

TC 23001.050

QMB Provisions

Qualified Medicare Beneficiaries (QMB)

TC 23001.070

Qualifying Individual 1 (QI1)

HI 00805.265

The Special Enrollment Period Definition

TC 23001.060

Specified Low-Income Medicare Beneficiaries (SLMB)

SI 00601.025

Protective Filing Oral Inquiry

GN 00903.100

Types of Referral Services SSA Provides

HI 03010.035

General Information about the Subsidy Application

TC 23001.035

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

G. Exhibits of letters

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.

1. Exhibit A – Draft text of SSA-L441, 2022

2. Exhibit B – Draft text of SSA-L441-SP, 2022

3. Exhibit C – Draft text of SSA-L447, 2023

4. Exhibit D — Draft text of SSA-L447-SP, 2023

5. Exhibit E – Draft text of SSA-L448, 2023

6. Exhibit F – Draft text of SSA-L448-SP, 2023

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HI 00815.025 - SSA Outreach to Low-Income Medicare Beneficiaries – Extra Help and Medicare Savings Programs - 05/16/2023
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