Prescription Drug Assistance
Program Service Center
JOHN Q. PUBLIC
123 MAIN ST
SPRINGFIELD OH 45501
On October 20, 2005, you submitted an Application for Help With Medicare Prescription
Drug Plan Costs. Since we already processed an earlier application for you, we are
taking no further action on this application.
The decision on the first application remains in effect for 12 months unless you have
a subsidy-changing event. A subsidy changing event is one of the following:
you and your spouse who lives with you divorce;
your spouse who lives with you dies;
you and your spouse separate;
you and your spouse have your marriage annulled; or
you and your separated spouse begin living together again.
If you have a subsidy-changing event, please call us toll-free at 1-800-772-1213.
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.