Identification Number:
HI 03001 TN 14
Intended Audience:See Transmittal Sheet
Originating Office:ORDP OISP
Title:Description of the Medicare Prescription Drug Coverage Program
Type:POMS Transmittals
Program:All Programs
Link To Reference:
 

PROGRAM OPERATIONS MANUAL SYSTEM
Part HI – Health Insurance
Chapter 030 – Eligibility for Subsidized Medicare Prescription Drug Coverage
Subchapter 01 – Description of the Medicare Prescription Drug Coverage Program
Transmittal No. 14, 01/02/2020

Audience

PSC: BA, CA, CS, DS, IES, ILPDS, IPDS, ISRA, PETE, RECONR, SCPS, TSA, TST;
OCO-OEIO: BET, CR, CTE, EIE, ERE, FCR, FDE, PETL, RECONE, RECONR;
Subsidy Appeals Unit (SAU): SDR, SDS, SDT;
OCO-ODO: BET, BTE, CCE, CR, CST, CTE, CTE TE, DEC, DES, PAS, PCS, PETE, PETL;
FO/TSC: CS, CS TII, CSR, CTE, DRT, FR, OA, OS, RR, TA, TSC-CSR;

Originating Component

OISP

Effective Date

Upon Receipt

Background

This is a Quick Action Transmittal. These revisions do not change or introduce new policy or procedure.

Summary of Changes

HI 03001.001 Description of the Medicare Part D Prescription Drug Program

Subsection J, revised the third sentence in the first paragraph. Deleted the 2018 base beneficiary premium amount and added the 2020 base beneficiary premium amount.

HI 03001.005 Medicare Part D Extra Help (Low-Income Subsidy or LIS)

Subsection G, updated years, added 2020 Medicare Part D resource limits and coverage amounts, removed 2018 Part D coverage chart.

HI 03001.020 Eligibility for Extra Help (Prescription Drug Low-Income Subsidy)

Subsection C.5, updated month/year example dates, deleted 2019 resource limits, and added 2020 resource limits.

HI 03001.001 Description of the Medicare Part D Prescription Drug Program

CITATIONS:

Sections 1144 and 1860D-1 through 1860D-15 of the Social Security Act

A. Introduction to the Medicare Part D prescription drug program

Public Law 108-173 , the Medicare Prescription Drug, Improvement, and Modernization Act of 2003, also known as the Medicare Modernization Act (MMA), amended Title XVIII of the Social Security Act to establish a Medicare prescription drug coverage program, Medicare Part D, effective January 1, 2006.

B. Policy – Public Law 108-173, Medicare Modernization Act (MMA)

The basic requirements for participation in the Medicare Part D prescription drug program are:

  • entitlement to Medicare Part A or Medicare Part B (or both); and

  • residence in the service area of the beneficiary’s Medicare prescription drug plan or provider.

Unlike Medicare Parts A and B, SSA does not process Part D enrollments. Medicare beneficiaries enroll in a Part D plan during an enrollment period with a prescription drug provider. Participants in the Part D program must meet deductible, premium, and copayment responsibilities. SSA administers a program to help low-income beneficiaries with their prescription drug coverage costs called Extra Help.

NOTE: An individual who is not a resident of the 50 States or the District of Columbia is not eligible for Extra Help with Medicare Part D prescription drug coverage. Additional information about Medicare Part D Extra Help is found in HI 03001.005 through HI 03001.020.

C. Policy – Public Law 110-275, Medicare Improvements for Patients and Providers Act (MIPPA)

Effective with applications filed on or after January 1, 2010 or redeterminations initiated on or after that date, the Medicare Improvements for Patients and Providers Act of 2008 (MIPPA), Public Law 110-275:

  • Requires SSA to transmit identity and financial data used to determine eligibility and the amount of Extra Help (also known as low-income subsidy, LIS, or subsidy) from the application process to the Medicaid State agency to initiate an application for the Medicare Savings Programs (MSP) unless the beneficiary objects;

  • Eliminates counting in-kind support and maintenance (ISM) as unearned income for Extra Help purposes; and

  • Eliminates counting the cash surrender value (CSV) of life insurance from resources for Extra Help purposes.

Effective January 1, 2009, MIPPA also eliminates any late-enrollment penalties for individuals eligible for Extra Help or deemed eligibles by statute. Previously the Centers for Medicare & Medicaid Services (CMS) administratively waived late enrollment penalties for this group; the statute eliminates the annual waiver.

NOTE: For information about MSP, see HI 00815.023.

D. Policy – Public Laws 111-148 and 111-152, Affordable Care Act (ACA)

The Affordable Care Act (ACA) addresses the following changes:

  • Gradually eliminates the Part D coverage gap popularly known as the “donut hole”;

  • Requires that higher-income beneficiaries pay an income-related monthly adjustment amount for their Medicare Part D prescription drug coverage premiums (IRMAA-D); and

  • Changes enrollment and disenrollment period rules for Medicare Advantage and Part D.

For additional information regarding the income-related monthly adjustment amount, see HI 01100.000.

E. Facts about the Medicare Part D prescription drug coverage program

Like Medicare Advantage (see HI 00208.066), participation in the Medicare Part D prescription drug program is voluntary. Medicare Part D coverage replaces Medicaid prescription drug coverage for beneficiaries receiving both Medicaid and Medicare. Medicaid beneficiaries have the option to disenroll from the Part D prescription drug program but there is no federal financial participation under Medicaid for prescription coverage for prescriptions available under Part D for Medicare beneficiaries with Part A, Part B or both.

1. Creditable coverage for Medicare Part D

Beneficiaries who have prescription drug coverage through a former or current employer or union are informed annually by the employer or union if the employment-related coverage qualifies as creditable coverage (i.e., prescription coverage at least equivalent to Part D coverage). HI 03001.001J explains further the term “creditable coverage”.

2. The donut hole

Most Medicare drug plans have a coverage gap or “donut hole.” The coverage gap begins after the beneficiary and drug plan have spent a certain amount of money for covered drugs, which results in the beneficiary paying all costs out-of-pocket for prescriptions up to a yearly limit. Starting in 2010, the ACA gradually eliminates the coverage gap in Medicare prescription drug coverage; the gap disappears completely by 2020. Beneficiaries in 2010 subject to the coverage gap who are not paying IRMAA receive a one-time $250 rebate payment. The first decrease in the gap starts in 2011 when beneficiaries who enter the gap will receive a 50% discount when purchasing Part D-covered brand name prescription drugs and a 7% discount for generic drugs. Out-of-pocket costs during a coverage gap will continue to decrease until 2020.

NOTE: There is no coverage gap in Extra Help, so there is no donut hole, and Extra Help beneficiaries will not receive the $250 rebate.

3. Contact information

Refer all questions regarding enrollment or choosing a prescription drug plan (PDP) or Medicare Advantage with prescription drug coverage (MA-PD) to CMS at to http://www.medicare.gov/sign-up-change-plans/get-drug-coverage/get-drug-coverage.html or 1-800-MEDICARE (TTY 1-877-486-2048). Beneficiaries can also obtain assistance selecting a plan through their State Health Insurance Assistance Program (SHIP). SHIP telephone contact information is on the back of the “Medicare & You” handbook or may be obtained by selecting the State at http://www.medicare.gov/contacts/organization-search-criteria.aspx .

Refer all questions regarding premiums to the PDP or MA-PD provider.

4. Deemed Eligibles for “Extra Help” low-income subsidy

Medicare-entitled beneficiaries receiving SSI, full Medicaid coverage, or who participate in a Medicare Savings Program (MSP, as defined in HI 00815.024), except Qualified Disabled and Working Individuals (QDWI), are deemed eligible for a low-income subsidy. This means they do not have to file an application for Extra Help and are auto-enrolled by CMS with a PDP or MA-PD unless the beneficiary selects a specific plan on his or her own. SSA and the States share files with CMS to determine these deemed eligibles and CMS notifies deemed eligibles that they are already eligible for the low-income subsidy and need not file an Extra Help application. CMS also notifies SSA of those who are deemed eligible for Extra Help. This information is available in the Medicare Application Processing System (MAPS).

If there is any doubt about an individual’s deemed status (e.g., there is no record on MAPS), take an Extra Help application.

F. SSA’s Part D roles and responsibilities

We maintain five primary roles in the administration of the Medicare Part D program:

  1. 1. 

    Providing general information to the public about the Medicare Part D program;

  2. 2. 

    Processing and make initial determinations on Extra Help applications, redeterminations, and appeals;

  3. 3. 

    Screening Part D questions for referral to CMS;

  4. 4. 

    Deducting Part D (and MA-PD) premiums that do not exceed $300 a month from Title II benefits when the beneficiary requests withholding. (If there is an arrearage, SSA cannot deduct the total of the current premium plus arrearage if it exceeds $300.) PDP or MA-PD premium withholding requests are not made to SSA; the beneficiary requests the PDP or MA-PD to have the premium withheld from the Title II benefit. The PDP or MA-PD transmits that information to CMS, and CMS requests SSA to withhold the Part D premium. SSA only deducts if the monthly premium (or premium plus any arrearage) does not exceed $300 and there are sufficient Title II benefits to pay the premiums; and

  5. 5. 

    Determining when IRMAA is applicable and deduct IRMAA-D from Social Security benefits when there are sufficient funds to cover the cost. However, if the Social Security benefit payment is not enough to cover the entire monthly IRMAA-D, CMS will bill the beneficiary for the IRMAA-D. Office of Personnel Management (OPM) annuitants will also have IRMAA-D withheld from their benefit payment. The Railroad Board will bill IRMAA-D separately.

Our responsibilities also include:

  • Coordinating Extra Help outreach activities;

  • Sending data used to make the Extra Help determination to the States to initiate an application for MSP unless the claimant objects. SSA sends data to the States Monday through Friday, except Federal holidays. Data will not be sent on individuals that are already deemed or where there is a duplicate application;

  • Providing the beneficiary with information about MSP and referrals to the State health insurance assistance programs (SHIPs);

  • Providing MSP model applications in English and 10 additional languages to beneficiaries upon request. SSA provides those applications as a courtesy; SSA does not complete or help complete MSP applications; and

  • Sharing IRMAA data with the Railroad Retirement Board (RRB), Office of Personnel Management (OPM), and Centers for Medicare & Medicaid Services (CMS) when appropriate.

NOTE: To become eligible for an MSP, beneficiaries apply directly with the Medicaid State agency or its designee. Unless the beneficiary declines having information shared with the State, filing an Extra Help application will initiate the State’s MSP application. The State may then contact the beneficiary for any additional information needed. For more information regarding SSA’s role in MSP applications, see HI 00815.024.

G. CMS’ Part D responsibilities

CMS has Federal oversight responsibility for the Medicare program, including Part D and MA-PD.

CMS’ responsibilities include:

  • Approving and selecting competitive bids from PDPs and MA-PDs;

  • Publishing regulations governing Medicare and State Medicaid agency policies and State agency procedures involving subsidy eligibility;

  • Establishing enrollment periods, including Special Enrollment Periods (SEPs--information about various SEPs can be found in HI 03001.001I in this section);

  • Determining and notifying those who are deemed eligible for the low-income subsidy;

  • Determining the actual dollar value of the subsidy for the beneficiary;

  • Enrolling beneficiaries eligible for Extra Help in a Part D plan if they fail to choose a plan on their own;

  • Assigning beneficiaries with Extra Help to a new Part D plan when their plan terminates or when an increase in their plan premium would cause them to have a premium liability the next year;

  • Sending notices to beneficiaries who lose deemed eligibility. (The notice includes an SSA application for Extra Help); and

  • Collecting IRMAA-D for direct-bill beneficiaries and for Social Security, RRB and OPM beneficiaries whose Federal benefits are insufficient to cover the full amount.

H. Medicare prescription drug coverage plans and premium payment

Medicare-approved prescription drug coverage plans are offered by private companies and may cover a range of generic and brand-name prescription medications that vary by provider and plan. Copays, deductibles, premiums, and coverage vary by provider and plan. Medicare beneficiaries who choose to enroll or disenroll in Part D must do so by enrolling or disenrolling with a prescription drug provider; they may also enroll indirectly with CMS through the www.medicare.gov website or by calling 1-800-MEDICARE.

1. Referring all contacts and questions on Medicare Part D

Refer all questions regarding the following Medicare Part D topics to the Medicare toll-free number, 1-800-MEDICARE (1-800-633-4227), or, for TTY users, 1-877-486-2048:

  • Enrollment,

  • Disenrollment, or

  • Choosing a PDP or MA-PD

Refer questions on any of the following Medicare Part D topics to the PDP or MA-PD, or to the Medicare toll-free number:

  • Charges,

  • Deductibles,

  • Copayments,

  • Premiums, (not IRMAA)

  • Premium withholding, or

  • Coverage of drugs or medical supplies under Part D.

NOTE: Although there are certain classes and types of drugs that must be covered by any Medicare-approved PDP or MA-PD, the specifics of which drugs are covered vary from provider-to-provider.

Follow the instructions in HI 01101.040 for screening IRMAA questions or inquiries. If a beneficiary questions an IRMAA determination or decision, see HI 01101.050.

2. Payment options

PDPs and MA-PDs provide payment options to all beneficiaries responsible for paying all or part of their Part D monthly premiums.

Beneficiaries may pay Part D premiums by:

  • Direct payment to the PDP or MA-PD,

  • Electronic billing (e.g., electronic funds transfer (EFT) or credit card), or

  • Deduction from monthly Title II Social Security benefits. SSA will not withhold Part D premiums if there are insufficient benefits available to cover the full premiums after other deductions. If the beneficiary’s Medicare Advantage or Medicare prescription drug coverage premium (or premium plus arrearage) exceeds $300.00, SSA cannot withhold from the benefit check. SSA notifies CMS that the PDP or MA-PD must direct-bill the beneficiary.

NOTE: Currently, Part D premiums are not withheld from OPM benefits. However, RRB members can have their Part D prescription drug plan premiums withheld from their RRB monthly benefit payments and should contact their PDP or MA-PD to request withholding of these premiums.

If the beneficiary pays IRMAA-D, the amount of the IRMAA-D ordinarily is withheld from the Title II, or OPM benefit. (RRB bills separately.) If the amount of the benefit is insufficient to cover the IRMAA-D entirely, CMS will bill for the entire IRMAA-D amount. See HI 01101.001 for more IRMAA-D information.

I. Medicare Part D enrollment periods and coverage effective dates

Beneficiaries who want Medicare Part D prescription drug coverage must enroll during a prescribed enrollment period as explained in the chart below. To enroll with a PDP or MA-PD, the beneficiary must reside within the PDP’s or MA-PD’s service area.

Beneficiaries will also be able to change providers during the Annual Coordinated Election Period (AEP) each year or during an SEP.

Beneficiaries do not enroll in Medicare Part D through SSA. Those who choose to enroll in Part D do so with a prescription drug provider or by joining a Medicare Advantage plan with prescription drug coverage.

Effective January 1, 2011, the Affordable Care Act allows Medicare Advantage plan enrollees to switch to original Medicare during the first 45 days of the year. A beneficiary who is enrolled in a Medicare Advantage plan may disenroll to change their election to coverage under the original fee-for-service program under Medicare Part A and Part B, and may elect creditable prescription drug coverage.

NOTE: An incarcerated individual cannot meet the requirement of residing in the service area of a plan, even if the correctional facility is located within the plan’s geographical service area. For Medicare Advantage and Part D eligibility and enrollment purposes, an incarcerated individual is a person confined to a correctional facility such as a jail or prison.

Type of Enrollment Period

Description

Effective Date of Part D Coverage

Initial Enrollment Period (IEP)

For Social Security beneficiaries, the IEP follows the Part B IEP rules, which is usually the 7-month period that begins 3 months before the month of entitlement to Medicare, through 3 months after the month Medicare entitlement begins.

 

Medicare enrollment information for beneficiaries with end stage renal disease (ESRD) or amyotrophic lateral sclerosis (ALS, also known as "Lou Gehrig's disease") can be found in DI 11036.001 and DI 45605.001, respectively.

 

When Medicare entitlement is awarded retroactively, the IEP begins the month the notice of entitlement is received and continues for 3 additional months after the notice.

 

EXAMPLE: Mr. Jackson received notification of his Medicare determination on 06/01/2008. He was informed in this notice that Medicare Part A was effective as of 07/01/2007.

Therefore, his Part D initial enrollment period begins in 06/2008 and ends 09/30/2008.

 

 

Beneficiaries eligible for Medicare prior to age 65, e.g., for disability, will have another IEP for Part B and Part D based upon attaining age 65.

For Medicare beneficiaries who are deemed eligible with full Medicaid, coverage is generally effective the month of enrollment, but not earlier than the Medicare entitlement date.

 

For beneficiaries without full Medicaid and those who are not deemed, enrollment requests are generally effective the next month, but not earlier than the Medicare entitlement date.

Annual Coordinated Election Period (AEP)

For years 2005 through 2010, the AEP begins November 15 and ends December 31.

Beginning 2011, dates for the AEP will change to October 15 through December 7.

Late-enrollment penalties may apply (see HI 03001.001J in this section). Beneficiaries may change or enroll with plans during this period each year.

For Medicare beneficiaries who are deemed eligible with full Medicaid, coverage is generally effective the month of enrollment, but not earlier than the Medicare entitlement date.

 

Generally, for all other AEP beneficiaries, coverage is effective January 1st of the next year, e.g., enrollments during the AEP of 2010 will have coverage effective January 1, 2011; enrollments during the AEP of 2011 will have coverage effective January 1, 2012.

Special Enrollment Period (SEP)

Special enrollment periods are periods outside of the usual IEP and AEP when an individual may elect a plan or change a current plan election. SEPs include, but are not limited to:

 

  • Individuals who were not eligible for Part D because they were incarcerated and have now been released;

  • A change in permanent residence outside of the plan’s service area;

  • A plan goes out of business or is decertified;

  • Loss or change of prescription drug coverage through an employer or union (current or retiree); or

  • The government or the plan provides incorrect information that makes enrollment late.

 

If a beneficiary has a break in creditable prescription drug coverage, he or she usually has 63 consecutive days to enroll during an SEP.

 

However, beneficiaries have continuing SEPs if they are eligible for Extra Help (subsidy) or deemed.

EXAMPLE: An individual is awarded LIS and CMS facilitates his enrollment into a PDP,

effective October 1st. The individual chooses another PDP and submits a request in November. He does so using the SEP and his enrollment is effective December 1st.

For Medicare beneficiaries who are deemed eligible with full Medicaid, coverage is generally effective the month of enrollment, but not earlier than the Medicare entitlement date.

 

For others, the SEP effective date is determined by the PDP/MA-PD and CMS and depends on the SEP type and circumstances.

 

Refer all questions regarding SEP enrollment or coverage to 1-800-MEDICARE or to the PDP or the MA-PD.

J. Medicare Part D late enrollment

Failure to enroll with a PDP or MA-PD during the IEP or an SEP without other creditable prescription drug coverage may result in a late enrollment fee. The PDP or MA-PD uses CMS data to set the fee. The penalty fee is 1% of the national base beneficiary premium amount ($32.74 for 2020 and $33.19 for 2019) for each month for which a beneficiary is eligible for Part D coverage but not enrolled. This penalty fee is permanent, like Part B surcharges.

The term “creditable prescription drug coverage” may include:

  • Coverage under a PDP or MA-PD;

  • Deemed eligibility or Medicaid coverage;

  • Group Health Plan (GHP) coverage;

  • State Pharmaceutical Assistance Program participation;

  • VA coverage;

  • Medigap with prescription drug coverage; or

  • Military service-related coverage including TRICARE

NOTE: There are no late-enrollment penalties for deemed or Extra Help eligibles.

K. References

  • HI 00208.066, The Medicare Advantage (MA) Program

  • HI 00815.023, Medicare Savings Programs Income Limits

  • HI 00815.024, SSA’s Role in Medicare Savings Programs (MSP) Applications

  • HI 00815.025, SSA Outreach to Low-Income Medicare Beneficiaries – Extra Help and Medicare Savings Programs

  • HI 01101.000, Medicare Income-Related Monthly Adjustment Amount

  • HI 03001.005, Medicare Part D Extra Help (Low Income Subsidy or LIS)

  • HI 03020.055, Income Limits for Subsidy Eligibility

  • HI 03030.025, Resource Limits for Subsidy Eligibility

  • HI 03050.000, Redeterminations

HI 03001.005 Medicare Part D Extra Help (Low-Income Subsidy or LIS)

A. Extra Help and deemed subsidy eligibles

The Medicare Part D Extra Help program helps Medicare beneficiaries with limited income and resources pay for prescription drug coverage. Eligible beneficiaries receive subsidized premiums, deductibles, and copayments. Subsidized premiums are paid to the prescription drug provider (PDP) or Medicare Advantage prescription drug plan (MA-PD) by the Centers for Medicare and Medicaid Services (CMS) and are based on the service area’s regional benchmark premiums. Extra Help eligibles with a full premium subsidy who choose to participate in a more expensive plan are responsible for the difference.

The Medicare Part D program assumes responsibility for prescription drug coverage for full Medicaid recipients with Medicare.

Certain beneficiaries are automatically deemed subsidy-eligible and should not complete an application for Extra Help. These beneficiaries have Medicare Parts A or B, or both, and are:

  • already entitled to Supplemental Security Income (SSI),

  • eligible for full Medicaid coverage, or

  • covered under one of the Medicare Savings Programs as a Qualified Medicare Beneficiary (QMB), Specified Low-Income Medicare Beneficiary (SLMB), or Qualified Individual (QI).

NOTE: Qualified Disabled Working Individuals (QDWI) are not deemed eligible for Extra Help. For more information about these groups, see HI 00815.023 and HI 00815.025.

B. SSA and Extra Help

If a beneficiary is not deemed eligible for Medicare Part D Extra Help, he or she may file an application with the State or SSA. However, SSA has primary responsibility for taking applications for Extra Help and making determinations on those applications in the 50 States and the District of Columbia. When a beneficiary applies for Extra Help, SSA determines eligibility and the applicable percentage of Extra Help premiums. An SSA eligibility determination indicates one of the following conditions:

  • Full premium subsidy of the service area’s benchmark base premium with no deductible and limited copayments;

  • Full premium subsidy of the service area’s benchmark base premium with reduced deductibles and copayments;

  • Partial premium subsidy of 75%, 50%, or 25% of the service area’s benchmark base premium with reduced deductibles and copayments; or

  • Not eligible for a subsidy.

NOTE: For information on basic eligibility requirements for Extra Help, see HI 03001.020.

Extra Help application editing or exception issues (e.g., answers omitted or numbers larger than the space provided on the form) are generally resolved in SSA’s Wilkes-Barre Direct Operations Center (WBDOC).

Issues that are not editing or exception problems, but are data inconsistencies with information available in SSA records and the information provided on the Extra Help application, are sent to the appropriate field office (FO) or Workload Support Unit (WSU) for resolution. If necessary, the FO or WSU contacts the applicant for verification of information.

Detailed information regarding the exception and verification processes is found in HI 03010.039 and HI 03035.005C.

SSA sends the subsidy determination notice to the beneficiary, including appeal procedures, and transmits the application subsidy determination data to CMS. Starting January 1, 2010, unless a beneficiary declines, data used for the Extra Help determination will be sent to the State to initiate the Medicare Savings Program (MSP) application process.

NOTE: For information on the Extra Help appeal process, see HI 03040.001.

An SSA subsidy determination of an allowance is generally effective:

  • the month the beneficiary applies for Extra Help if already enrolled with a PDP/MA-PD, or

  • the month after the month of enrollment with the PDP/MA-PD.

A subsidy determination cannot be effective before Medicare entitlement begins or before enrollment with a PDP/MA-PD becomes effective.

SSA periodically redetermines eligibility for Extra Help beneficiaries to determine continued eligibility for a full or partial subsidy. SSA redetermines eligibility for all Extra Help initial determinations made by SSA. More information about Extra Help redeterminations is available in HI 03050.011.

Effective January 2010, unless the claimant objects, SSA will transmit Extra Help determination data to the appropriate State Medicaid agency to begin the MSP application process.

C. CMS, deemed subsidy eligibles, and Extra Help eligibles

For individuals deemed subsidy-eligible and beneficiaries filing an application for Extra Help, CMS:

  • Determines if an individual is deemed eligible for the low-income subsidy based on monthly data from State Medicaid agencies and SSA’s records of SSI participation;

  • Automatically enrolls (auto-enrolls) deemed-eligible beneficiaries who have not yet enrolled with a PDP or MA-PD. CMS also assists in the enrollment of beneficiaries who are approved for Extra Help but have not enrolled in a PDP or MA-PD under a process called facilitated enrollment. (See HI 03001.010);

  • Sends notices to beneficiaries who lose their deemed status and provides an SSA application for Extra Help (Beneficiaries lose deemed status the end of the calendar year of their notification of termination.);

  • Determines the dollar value of Extra Help a beneficiary may receive from the percentage data provided by SSA;

  • Notifies SSA of Medicare terminations; and

  • Sends SSA data to support requests for Part D premium withholding (or stops Part D premium withholding) from the Title II benefit.

NOTE: Deeming is a CMS activity; SSA does not make these determinations and cannot address any appeals of deeming decisions.

D. Deemed eligibility and applying for Extra Help

Medicare beneficiaries are automatically deemed subsidy-eligible and should not apply for Extra Help if they:

  • have Medicaid;

  • participate in a QMB, SLMB, or QI program; or

  • receive SSI.

Almost all Medicare Part D Extra Help applications are taken and processed by SSA. A prescribed subsidy application filed with us includes the:

  • SSA-1020-OCR, scannable paper version (HI 03010.035B.1.) in English and Spanish;

  • i1020, online version on SSA’s Internet website (HI 03010.035B.3.); or

  • Intranet via the Medicare Application Processing System (MAPS) screens completed by an SSA employee (HI 03010.010).

State Medicaid agencies may use the Extra Help application, which may be a paper SSA-1020-OCR or i1020. However, if the Medicaid agency chooses to use a non-SSA application, the agency must process the application, make the subsidy determination (and subsequent annual redeterminations or appeals), and share applicable data with CMS directly. CMS shares the appropriate data with SSA. This is very rare.

E. Beneficiary contacts 800#, Field Office (FO), or Workload Support Unit (WSU)

The preferred method of filing for Medicare Part D Extra Help is through our online application, the i1020. Refer beneficiaries first to the online process at https://secure.ssa.gov/apps6z/i1020

1. 800# process

If a beneficiary calls and needs help with the Extra Help application or alleges that he or she did not receive a form but wants to file for Extra Help, 800# agents should follow Medicare Prescription Drug Subsidy eligibility and filing instructions.

2. FO and WSU process

If a beneficiary contacts the FO or and requires assistance completing the Extra Help application or alleges non-receipt of a form and wants to file for Extra Help, follow the instructions in HI 03010.001 through HI 03010.040.

F. Questions about enrollment

People who file an application and establish eligibility for Extra Help may or may not be enrolled with a PDP or MA-PD. Enrollment is generally effective the month after the enrollment request is filed with the PDP or MA-PD. (More information regarding specific enrollment periods and effective dates of coverage is found in HI 03001.001F.)

Extra Help beneficiaries who do not enroll with a PDP or an MA-PD are enrolled in a plan selected by CMS; however, they may choose not to be enrolled. For information about facilitated enrollment, see HI 03001.010.

Beneficiaries with questions about enrolling or choosing a PDP or MA-PD should call 1-800-MEDICARE (1-800-633-4227). The Medicare TTY number is 1-877-486-2048. Refer beneficiaries to their State Health Insurance Counseling and Assistance Program (SHIP) for assistance in choosing a PDP or MA-PD. SHIP telephone contact information is on the back of the “Medicare & You handbook or may be accessed by selecting the State at http://www.medicare.gov/contacts/organization-search-criteria.aspx .

G. Full and partial subsidies

An individual can qualify for a full or partial Medicare Part D subsidy depending on his or her income, resources (and those of the living-with spouse), and household size. The resources are compared to one of two resource limits for individuals and couples. A more detailed explanation of resource limits is in HI 03030.025.

Income is based on the Federal Poverty Level (FPL), which considers the number of persons in the household. To determine household size, a relative is considered in the same household as the beneficiary if the relative (by blood, marriage, or adoption) receives at least one-half support from the beneficiary or the living-with spouse. For more information about income and the FPL see HI 03020.055 and HI 03001.020C.

NOTE: When discussing Extra Help, it is important to remember that a person who receives a 100% premium subsidy is not necessarily “full subsidy eligible.” A person who fails to meet the lower resource standards may receive a 100% premium subsidy but may pay an annual deductible and higher copayments than a “full subsidy eligible” individual.

2020 resources standards chart for individuals/couples

With Burial Exclusion

Without Burial Exclusion

Lower Resources Level

$9,360/$14,800

$7,860/$11,800

Higher Resources Level

$14,610/$29,160

$13,110/$26,160

NOTE: For purposes of determining countable resources for Medicare Part D Extra Help subsidy eligibility $1,500 is excluded from an applicant’s countable resources if the applicant alleges that he or she expects to use some of his or her resources for funeral or burial expenses. For a married couple who live together, we exclude up to $3,000 ($1,500 for each member who alleges he or she expects to use some of his or her resources for funeral or burial expenses). For more information about resource exclusions see HI 03030.020.

The charts below explain the basic Part D benefit and the Extra Help available in 2020 and 2019 for each subsidy level and for non-institutional deemed eligibles. All resource limits shown include the $1,500 per person burial exclusion.

1. Part D coverage for 2020

  1. a. 

    For individuals/couples at 150% FPL or above, or with countable resources greater than $14,610/$29,160 or both (basic benefit)

    If income is

    150% FPL or above

    And resources are

    NONE to greater than resource limit for the year

    The deductible is

    $435

    The copayment is

    After deductible, 25% up to $4,020 in out-of-pocket drug cost

    The coverage gap is

    The beneficiary is responsible for 25% of out-of-pocket costs of brand-name drugs and 37% of out-of-pocket costs of generic drugs between $4,020 and $9,038.75. The beneficiary’s cost will continue to decrease each year until it reaches 25% by 2020 for both brand-name and generic drugs.

    Catastrophic coverage applies

    After $6,350 in total out-of-pocket covered drug costs are paid by the beneficiary (usually representing $9,038.75 in covered drugs), copayments of $3.60 for generic/preferred, and $8.95 for other covered medications.

  2. b. 

    For individuals/couples not eligible for Medicaid, but between 136% and 149% of FPL (Low-Income Subsidy)

    If income is

    Between 136% and 149% FPL

    • 25% premium subsidy from 146-149%

    • 50% premium subsidy from 141-145%

    • 75% premium subsidy from 136-140%

    And resources are

    $14,610 or less for individuals,

    $29,160 or less for couples

    The deductible is

    $89

    The copayment will be

    After deductible, 15% up to $6,350 in out-of-pocket drug costs

    The coverage gap is

    Covered – If the beneficiary is receiving Extra Help there is no coverage gap

    Catastrophic coverage will apply

    After $6,350 in out-of-pocket covered drug costs paid by beneficiary, copays of $3.60 for generic/preferred and $8.95 for other covered medications

  3. c. 

    For individuals/couples not eligible for Medicaid, but less than or equal to 135% of FPL (Low Income Subsidy)

    If income is

    Less than or equal to 135% FPL with higher resources level

    Less than or equal to 135% FPL with lower resources level

    And resources are

    Greater than $9,360, but do not exceed $14,610 for individuals

    Greater than $14,800, but do not exceed $29,160 for couples

    $9,360 for individuals,

    $14,800 for couples

    The deductible is

    $89

    NONE

    The copayment will be

    After deductible, 15% up to $6,350 in out-of-pocket drug costs

    $3.60 for generic/preferred and

    $8.95 for other medications

    The coverage gap is

    Covered – If the beneficiary is receiving Extra Help there is no coverage gap

    N/A

    Catastrophic coverage will apply

    After $6,350 in out-of-pocket covered drug costs are paid by the beneficiary, and copays of $3.60 for generic/preferred and $8.95 for other covered medications

    N/A

  4. d. 

    For non-institutionalized individuals deemed eligible for Extra Help

    If income is

    Over 100% FPL

    Up to and including 100% FPL and full Medicaid eligible

    And resources are

    Limited by the rules of the qualifying program

    Limited by the rules of the qualifying program

    The deductible is

    NONE

    NONE

    The copayment is

    $3.60 for generic/preferred and

    $8.95 for other covered medications

    $1.30 for generic/preferred and

    $3.90 for other covered medication

    The coverage gap is

    N/A

    N/A

    Catastrophic coverage is

    N/A

    N/A

2. Part D coverage for 2019

  1. a. 

    For individuals/couples at 150% FPL or above, or with countable resources greater than $14,390/$28,720 or both (basic benefit)

    If income is

    150% FPL or above

    And resources are

    NONE to greater than resource limit for the year

    The deductible is

    $415

    The copayment is

    After deductible, 25% up to $3,820 in out-of-pocket drug cost

    The coverage gap is

    The beneficiary is responsible for 25% of out-of-pocket costs of brand-name drugs and 37% of out-of-pocket costs of generic drugs between $3,820 and $7,653.75. The beneficiary’s cost will continue to decrease each year until it reaches 25% by 2020 for both brand-name and generic drugs.

    Catastrophic coverage applies

    After $5,100 in total out-of-pocket covered drug costs are paid by the beneficiary (usually representing $7,653.75 in covered drugs), copayments of $3.40 for generic/preferred, and $8.50 for other covered medications.

  2. b. 

    For individuals/couples not eligible for Medicaid, but between 136% and 149% of FPL (Low-Income Subsidy)

    If income is

    Between 136% and 149% FPL

    • 25% premium subsidy from 146-149%

    • 50% premium subsidy from 141-145%

    • 75% premium subsidy from 136-140%

    And resources are

    $14,390 or less for individuals,

    $28,720 or less for couples

    The deductible is

    $85

    The copayment will be

    After deductible, 15% up to $5,100 in out-of-pocket drug costs

    The coverage gap is

    Covered – If the beneficiary is receiving Extra Help there is no coverage gap

    Catastrophic coverage will apply

    After $5,100 in out-of-pocket covered drug costs paid by beneficiary, copays of $3.40 for generic/preferred and $8.50 for other covered medications

  3. c. 

    For individuals/couples not eligible for Medicaid, but less than or equal to 135% of FPL (Low Income Subsidy)

    If income is

    Less than or equal to 135% FPL with higher resources level

    Less than or equal to 135% FPL with lower resources level

    And resources are

    Greater than $9,230, but do not exceed $14,390 for individuals

    Greater than $14,600, but do not exceed $28,720 for couples

    $9,230 for individuals,

    $14,600 for couples

    The deductible is

    $85

    NONE

    The copayment will be

    After deductible, 15% up to $5,100 in out-of-pocket drug costs

    $3.40 for generic/preferred and

    $8.50 for other medications

    The coverage gap is

    Covered – If the beneficiary is receiving Extra Help there is no coverage gap

    N/A

    Catastrophic coverage will apply

    After $5,100 in out-of-pocket covered drug costs are paid by the beneficiary, and copays of $3.40 for generic/preferred and $8.50 for other covered medications

    N/A

  4. d. 

    For non-institutionalized individuals deemed eligible for Extra Help

    If income is

    Over 100% FPL

    Up to and including 100% FPL and full Medicaid eligible

    And resources are

    Limited by the rules of the qualifying program

    Limited by the rules of the qualifying program

    The deductible is

    NONE

    NONE

    The copayment is

    $3.40 for generic/preferred and

    $8.50 for other covered medications

    $1.25 for generic/preferred and

    $3.80 for other covered medication

    The coverage gap is

    N/A

    N/A

    Catastrophic coverage is

    N/A

    N/A

H. References

  • HI 00815.023, Medicare Savings Programs Income Limits

  • HI 00815.025, SSA Outreach to Low-Income Medicare Beneficiaries – Extra Help and Medicare Savings Programs

  • HI 03001.001F., Description of the Medicare Part D Prescription Drug Program

  • HI 03001.010, Facilitated Enrollment and Special Enrollment Period for Individuals Eligible for Extra Help (Low Income Subsidy)

  • HI 03010.010, Filing Applications

  • HI 03030.020, Resource Exclusions

  • HI 03010.035B.1., General Information about the Subsidy Application

  • HI 03010.039, Exception Processing

  • HI 03020.055, Income Limits for Subsidy Eligibility

  • HI 03030.025, Resource Limits for Subsidy Eligibility

  • HI 03035.005, Verification Policy within the Medicare Application Processing System (MAPS);

  • HI 03035.006, Verification and Documentation Process for Medicare Application Processing System (MAPS);

  • HI 03035.007, Verification and Documentation Instructions for Internal Revenue Service (IRS) data within the Medicare Application Processing System (MAPS);

  • HI 03035.008, Chart of IRS Transaction Types Used for Verification

  • HI 03040.001, Overview of Appeal Process for Medicare Part D Subsidy Determination

  • HI 03050.011, Redetermination of Eligibility

  • MSOM INTRANETMAPS 005.001 through MSOM INTRANETMAPS 005.013, MAPS Application Screens

  • TC 24020.020, Medicare Prescription Drug Subsidy Eligibility and Filing

HI 03001.020 Eligibility for Extra Help (Prescription Drug Low-Income Subsidy)

CITATIONS:

Section 1860D-14 of the Social Security Act;
Regulations 20 CFR 418.3101

A. Introduction to Medicare Part D eligibility

Under the provisions of the Medicare Part D program, Medicare beneficiaries entitled to Medicare Part A or Part B, or both, may enroll in the Medicare Part D prescription drug program through a Medicare prescription drug provider (PDP) or Medicare Advantage plan with prescription drug coverage (MA-PD) to obtain assistance with the purchase of covered medication. While Part D provides for discount prescription drugs, beneficiaries usually pay certain premiums, deductibles, and copayments.

Individuals eligible for Extra Help may receive full or partial help with their Part D premiums, pay a reduced or no deductible, and be responsible for smaller copayments.

B. Basic requirements for Extra Help eligibility

If the beneficiary is alive and meets all of the following conditions, he or she may be eligible to receive full or partial Extra Help:

  • Entitled to Medicare Part A (Hospital Insurance) or Medicare Part B (Supplementary Medical Insurance), or both;

  • Resides in one of the 50 States or the District of Columbia;

  • Not incarcerated;

  • Has income (including a living-with spouse’s income) that is less than 150% of the Federal Poverty Level (FPL), based on household size (HI 03020.055);

  • Has resources (including a living-with spouse’s resources) that are within the specified limits for eligibility (HI 03030.025);

  • Files an application (or is deemed eligible, as described in HI 03010.005B.2.f.) with SSA or with a State Medicaid Agency (HHS’ regulations encourage States to use the SSA process by completing the applications for Medicare Part D Extra Help, either the SSA-1020-OCR or i1020 and submit the application to us for processing); and

  • Enrolls with a PDP or MA-PD.

NOTE: For applications effectively filed January 1, 2010, or later, and initial determinations effective on or after January 1, 2010, in-kind support and maintenance (ISM) does not count as income and for purposes of determining eligibility for Extra Help, the cash surrender value of life insurance does not count as resources.

C. Income limits

1. General description of income limits

We base income limits on the FPL published in the Federal Register by the Department of Health and Human Services (HHS). Regardless of the age of family members, poverty levels remain the same.

Income after exclusions, whether earned and unearned, must be less than 150% of the FPL (based on size of the household) for subsidy eligibility.

2. Separate FPL for Alaska and Hawaii

One set of poverty levels applies to the 48 contiguous States and the District of Columbia. Alaska and Hawaii have separate and slightly higher poverty levels.

When an individual applies for Extra Help, we apply the FPL that corresponds to the individual's State of residence in the month that he or she files the application. We program the system to compute eligibility using the correct poverty levels for the applicable State of residence.

Moving to a State that has a higher or lower FPL is not a subsidy-changing event (SCE) and does not require a redetermination.

REMINDER: Be alert to situations where a move is the result of an SCE; e.g., an individual's spouse dies and the individual moves to live with an adult child. (For detailed information regarding SCEs, see HI 03050.005).

3. 2019 FPL table

  1. a. 

    48 States and the District of Columbia

    Family Size

    100%

    135%

    140%

    145%

    150%

    1

    $12,490.00

    $16,861.50

    $17,486.00

    $18,110.50

    $18,735.00

    2

    $16,910.00

    $22,828.50

    $23,674.00

    $24,519.50

    $25,365.00

    3

    $21,330.00

    $28,795.50

    $29,862.00

    $30,928.50

    $31,995.00

    4

    $25,750.00

    $34,762.50

    $36,050.00

    $37,337.50

    $38,625.00

    5

    $30,170.00

    $40,729.50

    $42,238.00

    $43,746.50

    $45,255.00

    6

    $34,590.00

    $46,696.50

    $48,426.00

    $50,155.50

    $51,885.00

    7

    $39,010.00

    $52,663.50

    $54,614.00

    $56,564.50

    $58,515.00

    8

    $43,430.00

    $58,630.50

    $60,802.00

    $62,973.50

    $65,145.00

    9

    $47,850.00

    $64,597.50

    $66,990.00

    $69,382.50

    $71,775.00

    10

    $52,270.00

    $70,564.50

    $73,178.00

    $75,791.50

    $78,405.00

    Additional

    $4,420.00

    $5,967.00

    $6,188.00

    $6,409.00

    $6,630.00

  2. b. 

    Alaska

    Family Size

    100%

    135%

    140%

    145%

    150%

    1

    $15,600.00

    $21,060.00

    $21,840.00

    $22,620.00

    $23,400.00

    2

    $21,130.00

    $28,525.50

    $29,582.00

    $30,638.50

    $31,695.00

    3

    $26,660.00

    $35,991.00

    $37,324.00

    $38,657.00

    $39,990.00

    4

    $32,190.00

    $43,456.50

    $45,066.00

    $46,675.50

    $48,285.00

    5

    $37,720.00

    $50,922.00

    $52,808.00

    $54,694.00

    $56,580.00

    6

    $43,250.00

    $58,387.50

    $60,550.00

    $62,712.50

    $64,875.00

    7

    $48,780.00

    $65,853.00

    $68,292.00

    $70,731.00

    $73,170.00

    8

    $54,310.00

    $73,318.50

    $76,034.00

    $78,749.50

    $81,465.00

    9

    $59,840.00

    $80,784.00

    $83,776.00

    $86,768.00

    $89,760.00

    10

    $65,370.00

    $88,249.50

    $91,518.00

    $94,786.50

    $98,055.00

    Additional

    $5,530.00

    $7,465.50

    $7,742.00

    $8,018.50

    $8,295.00

  3. c. 

    Hawaii

    Family Size

    100%

    135%

    140%

    145%

    150%

    1

    $14,380.00

    $19,413.00

    $20,132.00

    $20,851.00

    $21,570.00

    2

    $19,460.00

    $26,271.00

    $27,244.00

    $28,217.00

    $29,190.00

    3

    $24,540.00

    $33,129.00

    $34,356.00

    $35,583.00

    $36,810.00

    4

    $29,620.00

    $39,987.00

    $41,468.00

    $42,949.00

    $44,430.00

    5

    $34,700.00

    $46,845.00

    $48,580.00

    $50,315.00

    $52,050.00

    6

    $39,780.00

    $53,703.00

    $55,692.00

    $57,681.00

    $59,670.00

    7

    $44,860.00

    $60,561.00

    $62,804.00

    $65,047.00

    $67,290.00

    8

    $49,940.00

    $67,419.00

    $69,916.00

    $72,413.00

    $74,910.00

    9

    $55,020.00

    $74,277.00

    $77,028.00

    $79,779.00

    $82,530.00

    10

    $60,100.00

    $81,135.00

    $84,140.00

    $87,145.00

    $90,150.00

    Additional

    $5,080.00

    $6,858.00

    $7,112.00

    $7,366.00

    $7,620.00

4. 2018 FPL table

48 States and the District of Columbia

Family Size 100% 135% 140% 145% 150%
1 $12,140.00 $16,389.00 $16,996.00 $17,603.00 $18,210.00
2 $16,460.00 $22,221.00 $23,044.00 $23,867.00 $24,690.00
3 $20,780.00 $28,053.00 $29,092.00 $30,131.00 $31,170.00
4 $25,100.00 $33,885.00 $35,140.00 $36,395.00 $37,650.00
5 $29,420.00 $39,717.00 $41,188.00 $42,659.00 $44,130.00
6 $33,740.00 $45,549.00 $47,236.00 $48,923.00 $50,610.00
7 $38,060.00 $51,381.00 $53,284.00 $55,187.00 $57,090.00
8 $42,380.00 $57,213.00 $59,332.00 $61,451.00 $63,570.00
9 $46,700.00 $63,045.00 $65,380.00 $67,715.00 $70,050.00
10 $51,020.00 $68,877.00 $71,428.00 $73,979.00 $76,530.00
Additional $4,320.00 $5,832.00 $6,048.00 $6,264.00 $6,480.00

Alaska

Family Size 100% 135% 140% 145% 150%
1 $15,180.00 $20,493.00 $21,252.00 $22,011.00 $22,770.00
2 $20,580.00 $27,783.00 $28,812.00 $29,841.00 $30,870.00
3 $25,980.00 $35,073.00 $36,372.00 $37,671.00 $38,970.00
4 $31,380.00 $42,363.00 $43,932.00 $45,501.00 $47,070.00
5 $36,780.00 $49,653.00 $51,492.00 $53,331.00 $55,170.00
6 $42,180.00 $56,943.00 $59,052.00 $61,161.00 $63,270.00
7 $47,580.00 $64,233.00 $66,612.00 $68,991.00 $71,370.00
8 $52,980.00 $71,523.00 $74,172.00 $76,821.00 $79,470.00
9 $58,380.00 $78,813.00 $81,732.00 $84,651.00 $87,570.00
10 $63,780.00 $86,103.00 $89,292.00 $92,481.00 $95,670.00
Additional $5,400.00 $7,290.00 $7,560.00 $7,830.00 $8,100.00

Hawaii

Family Size 100% 135% 140% 145% 150%
1 $13,960.00 $18,846.00 $19,544.00 $20,242.00 $20,940.00
2 $18,930.00 $25,555.50 $26,502.00 $27,448.50 $28,395.00
3 $23,900.00 $32,265.00 $33,460.00 $34,655.00 $35,850.00
4 $28,870.00 $38,974.50 $40,418.00 $41,861.50 $43,305.00
5 $33,840.00 $45,684.00 $47,376.00 $49,068.00 $50,760.00
6 $38,810.00 $52,393.50 $54,334.00 $56,274.50 $58,215.00
7 $43,780.00 $59,103.00 $61,292.00 $63,481.00 $65,670.00
8 $48,750.00 $65,812.50 $68,250.00 $70,687.50 $73,125.00
9 $53,720.00 $72,522.00 $75,208.00 $77,894.00 $80,580.00
10 $58,690.00 $79,231.50 $82,166.00 $85,100.50 $88,035.00
Additional $4,970.00 $6,709.50 $6,958.00 $7,206.50 $7,455.00

5. Special procedures when the annual FPL table rates are unavailable for subsidy determinations

The annual FPL table rates are generally published in the Federal Register and available for program use in late January (e.g., 01/2020). The Medicare Application Processing System (MAPS) cannot use the Title II COLA monthly benefit credited (MBC) to determine subsidy amounts until after publication of the annual FPL table rates. Consequently, the subsidy determination program uses the MBC effective November (e.g., 11/2019), until the new table rates are available.

You must use special procedures for Title II beneficiaries whose month of entitlement is December or later, because these beneficiaries do not have an MBC for November. For these beneficiaries, MAPS will either:

  • Deny the application if the resources exceed the current limits: in 2020, $14,610 for a single beneficiary and $29,160 for a couple (systems includes the $1500 per person for burial expenses); or

  • Award the application if the subsidy level is 135% or less using prior year’s FPL table rates.

If neither of the situations in the two prior bulleted items applies to the claimant, MAPS places the application in “Hold” status, pending receipt of the new FPL table.

Cases in “Hold” status receive the following messages dependent upon the following actions:

  • When you click on the “Submit to Subsidy Determination” button on the Development Worksheet (DWMP) screen, you receive the message: “Application is Pending – Awaiting Federal Poverty Level Table Update.”

  • When you query the current application status, both the “Application Data” and “Status” sections on the Query (QDIS) screen reflect the message: “Awaiting Federal Poverty Values for the Current Year.

  • The “Query Sub Menu” (QSMS) screen reflects the same message as the “Application Data” and “Status” sections on the QDIS screen: “Awaiting Federal Poverty Values for the Current Year.”

6. FPL percentage and the amount of Extra Help (premium subsidy)

We determine the amount of a beneficiary’s Extra Help with Part D, also known as the premium subsidy, by the relationship of his or her income (and that of his or her living-with spouse) to the appropriate FPL. For instance, if an individual or couple has income less than 135% of the FPL (and resources are below the specified limit for an individual or couple), they may be eligible for 100% premium subsidy. For a detailed explanation of income limits, see HI 03020.055.

The percent of subsidy assistance depends on the level of income, as shown in the following chart.

Countable Income is:

Premium
Subsidy

Up to 135% of FPL

100%

More than 135% FPL, but not more than 140%

75%

More than 140% FPL, but not more than 145%

50%

More than 145% FPL, but less than 150%

25%

150% FPL or more

None

NOTE: We limit low-income premium subsidies to the greater of the lowest plan premium or the CMS-set “benchmark” amount in the person’s area. Therefore, a person with income below 135% of the FPL may still be responsible for paying a portion of the plan’s premium if he or she enrolls in a plan whose premium exceeds the area benchmark. Refer all questions regarding premiums to the PDP or MA-PD provider.

D. References

  • HI 03010.005 Interviewing for Medicare Part D Extra Help

  • HI 03020.055 Income Limits for Subsidy Eligibility

  • HI 03030.025 Resource Limits for Subsidy Eligibility

  • HI 03050.025 Subsidy-Changing Event (SCE) and Other Event (SCEs)

  • HI 03050.045 Manual Correction Process for the Extra Help Application


HI 03001 TN 14 - Description of the Medicare Prescription Drug Coverage Program - 1/02/2020