BASIC (05-05)

HI 03094.605 Application Filed by Deemed Eligible

A. Purpose/Use

The “Application Filed by Deemed Eligible” notice is generated when a subsidy application is filed by a Supplemental Security Income (SSI) beneficiary. The notice advises the beneficiary that he is already deemed eligible as a result of being on SSI. This notice is generated by MAPS.

B. Sample Notice for Application Filed By Deemed Eligible

Social Security Administration

Medicare Prescription Drug Assistance

Important Information

                                                                 Great Lakes Program Service Center

                                                                 600 West Madison Street

                                                                 Chicago, Illinois 60661-2474

Date: November 1, 2005

                                                                 Social Security Number: 123-00-6789

JOHN Q. PUBLIC

123 MAIN ST

SPRINGFIELD OH 45501

On October 25, 2005, you submitted an Application for Help with Medicare Prescription Drug Plan Costs. Because you receive Supplemental Security Income, you are automatically eligible for extra help with Medicare prescription drug plan costs. We do not need to process your application.

If You Have Any Questions

For information about 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.

For information about the extra help with the costs related to 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.

If you do call, please have this letter with you. It will help us answer your questions.

                                                                                      Regional Commissioner


To Link to this section - Use this URL:
http://policy.ssa.gov/poms.nsf/lnx/0603094605
HI 03094.605 - Application Filed by Deemed Eligible - 07/07/2006
Batch run: 01/27/2009
Rev: