Prescription Drug Assistance
Date: December 11, 2005
Social Security Number: 123-00-6789
JOHN Q. PUBLIC
123 MAIN ST
SPRINGFIELD OH 45501
On December 10, 2005, we received a partially completed Internet application for help
with Medicare prescription drug plan costs for you. Before we can decide if you are
eligible, you must file an application.
What To Do Next
The date an application is filed can make a difference in when the help for Medicare
prescription drug plan costs begins. If your application is filed by February 9, 2006,
we will use December 10, 2005, the date John Smith first started the Internet application,
as the filing date.
What Will Happen
If you file an application, we will review the claim and make a decision. If you do
not agree with what we decide, you will be able to appeal the decision.
If You Have Any Questions
For information about the Medicare prescription drug plans or other Medicare issues,
visit www.medicare.gov on the Internet or call toll-free 1-800-MEDICARE (1-800-633-4227). If you are deaf
or hard of hearing, you may call the Medicare TTY number toll-free at 1-877-486-2048.
If you do call, please have this letter with you. It will help us answer your questions.
For information about the extra help with the costs related to the Medicare prescription
drug plans or general information about Social Security, visit our website at www.socialsecurity.gov on the Internet. You may also call Social Security toll-free at 1-800-772-1213. If
you are deaf or hard of hearing, you may call our TTY number toll-free at 1-800-325-0778.
We can answer most questions by phone.