BASIC (05-05)

HI 03094.715 Good Cause Denial for Subsidy Continuation

A. Purpose/Use

“Good Cause Denial for Subsidy Continuation” notice is sent when good cause cannot be found for subsidy continuation. This notice is created in the Document Generation System (DGS) used in the Subsidy Appeals Unit.

B. Sample Notice of Good Cause Denial for Subsidy Continuation

Social Security Administration

Medicare Prescription Drug Assistance

Important Information

                                                                               SDS return address

                                                                               Date: November 23, 2005

                                                                               Social Security Number: 123-00-6789

JOHN Q. PUBLIC

123 MAIN ST

SPRINGFIELD OH 45501

We are writing to you about your request for a review of our determination that you will no longer be able to get help with your Medicare prescription drug plan costs. Because you waited more than 10 days to ask for a review and did not have a good reason for the delay, we must deny your request to get the same subsidy amount until we decide your case.

You Asked For A Review Too Late

We sent you a letter on September 1, 2005 to tell you about our determination. The letter explained that if you appealed in 10 days you would continue to get the same subsidy amount until we decided your case. The 10 days started the day after you got the letter. You asked for a review on September 25, 2005. This is after the 10-day time limit.

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.

                                                                                   Subsidy Determination Unit Reviewer


To Link to this section - Use this URL:
http://policy.ssa.gov/poms.nsf/lnx/0603094715
HI 03094.715 - Good Cause Denial for Subsidy Continuation - 06/20/2006