BASIC (05-05)

HI 03094.505 Redetermination - Subsidy Changing Event

A. Purpose/Use

Redetermination Notice (Subsidy Changing Event) is sent out as a cover letter when requesting a recipient to complete a redetermination form as a result of a subsidy changing event. This notice is automatically sent out by the system when a subsidy changing event report is entered on the Changing Events Screen and a new SSA-1020 is not entered online.

This notice will also be used for “Other” Changes (non-subsidy changing events) from 8/05-12/05.

B. Sample Notice of Review for Subsidy Changing Event Redeterminations

Social Security Administration

Medicare Prescription Drug Assistance

Notice of Review

Date: February 1, 2006

Social Security Number: 123-00-6789

JOHN Q. PUBLIC

123 MAIN ST

SPRINGFIELD OH 45501

Because of the report you made to us, we must review your eligibility for extra help with Medicare prescription drug plan costs. We check to be sure that you are still eligible and that your extra help, also known as the subsidy, is correct. We want to make this review as simple as possible for you and without the need to visit the office. Therefore, we are asking you to complete the same form you completed when you applied for this extra help.

What We Will Do To Review Your Case

As part of the review, we looked at the information you told us when you applied for the extra help with Medicare prescription drug plan costs. Your continued eligibility is determined by the amount of your income, resources, and household size. If you have a spouse and you are living together, your total income and resources count.

What You Need To Do For This Review

  • Please complete the enclosed form.

  • Sign and return the form in the enclosed envelope within 90 days.

  • Please use this form instead of using the form on our Internet website.

If This Form Is Not Returned

If this form is not returned within 90 days your help with Medicare prescription drug plan costs will be terminated.

If you are waiting for information from another agency or need assistance, you may call Social Security toll free at 1-800-772-1213. If you do need assistance we can give you an additional 30 days to return the form to us.

                                                                                 Regional Commissioner


To Link to this section - Use this URL:
http://policy.ssa.gov/poms.nsf/lnx/0603094505
HI 03094.505 - Redetermination - Subsidy Changing Event - 07/07/2006
Batch run: 01/27/2009
Rev:07/07/2006