Identification Number:
HI 03010 TN 48
Intended Audience:See Transmittal Sheet
Originating Office:ORDP OISP
Title:Applications
Type:POMS Full Transmittals
Program:Medicare
Link To Reference:
 

PROGRAM OPERATIONS MANUAL SYSTEM

Part HI – Health Insurance

Chapter 030 – Eligibility for Subsidized Medicare Prescription Drug Coverage

Subchapter 10 – Applications

Transmittal No. 48, 02/01/2024

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, PETE, PETL, RECONR;
FO/TSC: CS, CS TII, CSR, CTE, DRT, FR, OA, OS, RR, TA, TSC-CSR;

Originating Component

OISP

Effective Date

Upon Receipt

Background

This transmittal provides new policy to support the legislative changes mandated in the Inflation Reduction Act of 2022, section 11404, which expands Medicare Part D Extra Help (Low Income Subsidy or LIS) full subsidy eligibility and ends Extra Help partial subsidy effective January 1, 2024.

 

Summary of Changes

HI 03010.005 Interviewing For Medicare Part D Extra Help

Subsection "A":

  • Changed title from Introduction to Background to clarify section purpose.

  • Added subsection numbers to visually separate Medicare Improvements Patients Providers Act of 2008 (MIPPA) language from IRA language.

  • Added subsection to include the new Inflation Reduction Act Legislation of 2022, section 11404 language.

Subsection "B": Made minor formatting changes to improve clarity.

Subsections "B", "C", and "D": Corrected outdated hyperlinks.

Subsection "F":

  • Removed outdated reference to temporary MIPPA interviewing guidelines.

  • Added language about IRA change.

Revised this section as part of the Inclusive Language Initiative.

 

HI 03010.010 Filing Applications

Subsections "A1", "A.2", "D", and "F.3" - Corrected capitalization.

Subsections "D", "F.4.b", and "F.5.b" - Corrected outdated hyperlinks.

Subsection "D": Minor formatting to improve clarity.

Subsection "F.2.b": Added language about new IRA legislation and a system automatic conversion to active partial subsidy cases with no open issues or pending actions, giving them full subsidy effective January 1, 2024.

Revised this section as part of the Inclusive Language Initiative.

HI 03010.005 Interviewing For Medicare Part D Extra Help

A. Background

SSA helps claimants and beneficiaries decide whether or not to apply for Extra Help.

NOTE: In discussions with the public, be sure to refer to Part D as “Medicare Prescription Drug Coverage” and refer to the subsidy as “Extra Help with prescription drug coverage.”

1. Medicare Improvements for Patients and Providers Act (MIPPA)

Public Law 110-275, the Medicare Improvements for Patients and Providers Act of 2008 (MIPPA) expands SSA's responsibility to Extra Help (sometimes known as low-income subsidy (LIS) eligibles). Effective for Extra Help applications filed on or after January 1, 2010 and initial determinations effective on or after January 1, 2010, SSA:

  • No longer counts in-kind support and maintenance (ISM) as income or the cash surrender value (CSV) of life insurance policies as resources;

  • Sends data used for Extra Help determinations to state Medicaid agencies to initiate an application for the Medicare Savings Programs (MSPs) eligibility groups, unless the beneficiary declines to apply for the MSPs through the Extra Help application;

    NOTE: 

    The Medicare Savings Programs are Medicaid eligibility groups that cover Parts A and/or B premiums, and often, cost-sharing for individuals with limited incomes and resources.

  • Provides general information on the MSPs, including how to get help applying through the State health insurance assistance program; and

  • When requested, gives beneficiaries their state MSP contact information or directs them to their state website.

    For help applying for the MSP through the State, direct beneficiaries to Beneficiary Resources | Medicaid.

    IMPORTANT: 

    The MIPPA changes to ISM and CSV of life insurance are only for Extra Help. The changes do not affect countable income or resources for any other program.

2. Inflation Reduction Act (IRA)

Public Law 117-169, the Inflation Reduction Act of 2022 (IRA), section 11404 effective January 1, 2024:

  • Increases the income limit for full subsidy from 135 percent of the Federal Poverty Level (FPL) to income below 150 percent of the FPL;

  • Increases the resource limits for full subsidy to what had been the high single and married resource limits for the partial subsidy and eliminates the lower single and married resource limits;

  • Provides full subsidy to all Extra Help beneficiaries;

  • Ends Extra Help partial subsidy eligibility; and

  • Provides $0 cost sharing above the annual out of pocket maximum and for vaccines recommended by the Advisory Committee on Immunization Practices (ACIP).

    NOTE: 

    For information regarding low and high resource limits, see HI 03001.005.

B. Procedure for Extra Help interviewing

1. When to discuss the prescription drug subsidy

Information about Extra Help should be shared with each Title II or end stage renal disease (ESRD) beneficiary who:

  • has Medicare;

  • is eligible for Medicare; or

  • inquires about a prescription drug coverage plan or prescription drug coverage.

Field offices (FOs) should give copies of the worksheet, “Understanding the Extra Help With Your Medicare Prescription Drug Plan,” SSA Publication No. 05-10508, ICN 470112 to all claimants and beneficiaries who visit the FO and who want to:

  • file for the Extra Help with Medicare prescription drug coverage costs, including beneficiaries who have been notified they may no longer meet deemed status, see (HI 03010.010A); or

  • file for Title II benefits and are enrolled in, entitled to, or filing for Medicare; or

  • discuss a post-entitlement action (e.g., a Social Security or Medicare letter or a change of address) and are enrolled in or entitled to Medicare.

FOs may download the worksheet from https://www.ssa.gov/pubs/EN-05-10508.pdf in English.

NOTE: 

It is not necessary to recontact beneficiaries about Extra Help who:

  • file an iClaim application. Links to information about Medicare Part D and Extra Help are presented on the “Next Steps” page of the application;

or

  • become entitled to Medicare as a result of an appeal. SSA automatically sends an application if data indicates the beneficiary meets the income criteria.

2. What to discuss with the beneficiary

Explain that:

  • Extra Help is for people who are eligible for Medicare benefits, see (HI 03001.020) for eligibility criteria, and see (HI 03001.010) for information on enrollment periods.

  • Participation is voluntary.

  • Extra Help assists with Medicare prescription drug coverage or Medicare Advantage costs through subsidized premiums, deductibles, and co-payments.

  • Since January 1, 2010, unless the claimant opts out, SSA sends data used to make the Extra Help determination to the claimant’s state to initiate an MSP application. The MSPs help with other Medicare cost-sharing, such as Medicare Part B premiums.

  • There are income and resource limits to qualify for the subsidy, see (HI 03001.020) for eligibility criteria. Therefore, the claimant must provide information about their (and the living-with spouse’s) income and resources on the application.

NOTE: Effective January 1, 2010, SSA no longer counts ISM or the CSV of life insurance to determine Extra Help (LIS) eligibility or the level of subsidy.

C. How a beneficiary gets Extra Help

Extra Help with prescription drug coverage involves a two-step process. Claimants must:

  • apply for the subsidy; and

  • be enrolled in a Medicare prescription drug coverage plan or MA-PD.

The claimant may take either step first. However, claimants who are awarded a subsidy and are not already enrolled with a prescription drug plan (PDP) or Medicare Advantage prescription provider (MA-PD), are enrolled automatically by the Centers for Medicare & Medicaid Services (CMS). CMS notifies the claimant of the plan selection and provides instructions for changing plans or opting out of enrollment.

When members of the public ask questions about enrollment in a prescription drug coverage plan or choice of providers, refer them to 1-800-MEDICARE or their servicing State Health Insurance Assistance Program (SHIP). The telephone number of the appropriate SHIP is on the back of the CMS publication titled Medicare & You | Medicare. SHIP contact information is also available online at "Contact Medicare" webpage or at shiphelp.org.

D. Beneficiaries who are automatically eligible for Extra Help

Some beneficiaries are automatically eligible for Extra Help (i.e., deemed eligible). These beneficiaries have Medicare and coverage in:

  • Supplemental Security Income (SSI) benefits (including 1619(b)), or

  • Full-benefit Medicaid coverage, and/or

  • One of the primary MSP eligibility groups: Qualified Medicare Beneficiary (QMB) group (SI 01715.005), Specified Low-Income Medicare Beneficiary (SLMB) group (SI 01715.005), or Qualifying Individual (QI) group (HI 00815.025).

    NOTE: Qualified Disabled Working Individuals (QDWI) are NOT deemed for Extra Help. See (HI 00815.023) and (HI 00815.025) for more information about this group.

Deemed eligibles should not file an Extra Help application. CMS notifies deemed eligibles of their eligibility. CMS also notifies them of the plan selection and provides instructions for changing plans or opting out of enrollment. See (HI 03001.001F.4) and (HI 03001.001J).

E. Title II or Title XVI issues

Take the appropriate action to resolve any issues that arise during the interview relating to other program benefits, (e.g., representative payee development appears to be warranted or a disabled insurance benefit (DIB) beneficiary reports workers’ compensation benefits or earnings that are not reflected on the record).

F. After the initial discussion

Each year, beneficiaries who are notified by CMS of loss of deemed status receive a copy of the Extra Help application to complete. SSA may receive applications from those who are no longer deemed eligible as early as September. Since deemed eligibility lasts throughout the current year, applications completed by those who loose deemed status are effective January 1 of the next year.

After the discussion outlined in subsection B. above, take an Extra Help application, unless the beneficiary chooses not to file. Filing an Extra Help application:

  • permits SSA to make a formal determination of eligibility for Extra Help and whether the claimant should receive a subsidy;

  • assures that the claimant can receive the Extra Help for any months that they are eligible and enrolled in a Medicare Part D or MA- PD plan;

  • permits the claimant to start the MSP application process;

  • gives appeal rights if the claimant disagrees with the determination; and

  • serves as a protective filing for Supplemental Security Income (SSI).

NOTE: 

Effective January 1, 2024, all Extra Help beneficiaries receive full subsidy. A partial subsidy determination can only be made on an Extra Help case that has a coverage start date before January 1, 2024. To locate the coverage state date field in MAPS, see MS 03301.008C. [11-D]. For information about MAPS determination dates, see MS 03206.021.

Follow procedures in HI 03010.020B.2. when a Title II claimant is potentially eligible for the subsidy.

G. References

HI 03010.010 Filing Applications

CITATIONS:

Section 1860D-14(a)(3)(B) of the Social Security Act, 20 CFR 418.3220, 418-3225

A. Policy - valid application

A claimant or personal representative acting on the claimant’s behalf (see HI 03010.010B) must file a valid application to become eligible for the subsidy. EXCEPTION: Deemed claimants who meet the criteria in HI 03010.005D do not have to file an application. Rather, The Centers for Medicare and Medicaid Services (CMS) will send SSA a file on deemed eligibles. This information is then updated to the Medicare Application Processing System (MAPS).

NOTE: When deemed status is no longer met, individuals are notified toward the end of the year and may file an application as early as September 1st for the next year’s subsidy (see HI 03010.005F).

1. Valid application

To be valid the:

  1. a. 

    Application must be on a prescribed form (as described in the next section);

  2. b. 

    Application must be filed:

    • with a Social Security Administration (SSA) employee at one of our offices; or

    • with a SSA employee who is authorized to receive it at a place other than one of our offices; or

    • electronically through SSA’s Internet website, or

    • with a State Medicaid Agency; and

  3. c. 

    Claimant must be alive on the first day of the month in which the application is filed.

NOTE: A SSA application filed with the State must be adjudicated by SSA, and a state application filed with SSA must be adjudicated by the state.

2. Prescribed subsidy application filed with SSA

A prescribed subsidy application filed with SSA includes the:

  • SSA-1020-OCR, scannable paper version

  • i1020, online version on SSA’s Internet website

  • Intranet (via Medicare Application Processing System (MAPS)) completed by SSA employees.

A state subsidy application form is also a valid application but only if it is filed with and processed by the Medicaid State agency and communicated to CMS. The Department of Health and Human Services’ (HHS) regulations encourage states to use the SSA application (i.e., the SSA-1020-OCR or the i1020). However, if a person insists on a state determination, the State must use its own process. For any applications processed by the State, the appeal will also be processed by the State. Therefore, individuals who contact SSA with questions regarding their state application and/or appeal should be referred to the state.

B. Policy - proper applicant

In accordance with the HHS’ regulation 42 CFR 423.772 , a proper applicant to file a subsidy application is a claimant or a claimant's personal representative.

A personal representative is defined as:

  • An individual who is authorized to act on behalf of the claimant;

  • Someone who is acting responsibly on the claimant’s behalf because the claimant is incapacitated, or incompetent; or

  • An individual of the claimant’s choice who is requested by the claimant to act as the claimant's representative in the application process.

NOTE: A personal representative can include a representative of a third party entity, e.g., the Office of Aging, etc.

The claimant or the claimant's personal representative will complete and sign the application for the subsidy using the Social Security Administration (SSA) alternative signature proxy methods. Signature proxy replaced the traditional pen-and-ink signature for applications and other claims-related processes (see GN 00201.015 for the policy and procedures for using signature proxies). SSA will assume that the application is completed by an authorized person. There is no need to determine if a proper applicant filed the application. In addition, there is no formal representative payee process applicable with the subsidy.

IMPORTANT: The fact that a person is acting as a personal representative does not mean that SSA can disclose information to that person from SSA’s records. See GN 03305.001 regarding disclosure to third parties.

C. Policy - scope of application

The subsidy application is called “Application for Help with Medicare Prescription Drug Plan Costs” and is not an application for any other program benefit administered by SSA to which the claimant may be eligible to receive. The application, however, is a protective filing for Supplemental Security Income (see HI 03010.020A).

D. Policy - life of application

The subsidy application will remain pending until SSA makes a final decision on it. A determination will not become final until the appeal period expires or a decision on any appeal filed on a subsidy determination (e.g., a request for appeal on the calculation of income and resources) is issued to the claimant. See HI 03040.001C.1. for ways to request an appeal. If a claimant meets all the requirements for the subsidy (except for enrollment in a Part D or MA-PD plan) and is in an enrollment period at the time of filing the application or before we make a final decision, the claimant will be sent a notice about their eligibility for the subsidy and will be advised of the need to enroll in a Prescription Drug Plan or a Medicare Advantage Prescription Drug Plan. Otherwise, if the claimant cannot be enrolled in Part A or B because the claimant is not in an enrollment period, the subsidy application will be denied. If the individual is in an enrollment period but does not enroll in a plan, CMS will select and enroll the individual in a plan at the end of their enrollment period.

If the individual is not entitled to Medicare Part A and/or enrolled in Medicare Part B and does not have Medicare coverage through the Railroad Retirement Board (RRB) but is in an enrollment period at the time the application for the subsidy is processed through Subsidy Determination, the record will be held in a conditional status until the individual files for Medicare. A notice will be sent to the individual which states that SSA will not make a determination until the individual become entitled to Part A and/or enrolled in Part B. Once the individual files for Medicare, the system will issue the award or pre-decisional notice. If the claimant does not become entitled to Medicare Part A and/or enroll in Medicare Part B before the first redetermination is scheduled, the record will be denied and the individual must file a new application for extra help and become entitled to Medicare Part A and/or enroll in Medicare Part B during a subsequent enrollment period. See HI 03001.001J for Part D enrollment periods and HI 00805.010, HI 00805.015, and HI 00805.025 for Medicare Part B enrollment periods.

If the individual is not entitled to Medicare Part A and/or enrolled in Medicare Part B at the time the application is filed and is not in an enrollment period, SSA will deny the application and send the individual a notice. The notice will include appeal rights and inform the individual that they are not eligible for the subsidy because they are not entitled to Medicare Part A and/or enrolled in Medicare Part B.

E. Policy - death before effectuation

If the claimant is alive on the first day of the month in which the subsidy application is filed, but dies before SSA processes it, a subsidy eligibility determination is required from the filing date month through the month of death, if the information obtained shows the claimant was enrolled in a PDP. If the claimant was not enrolled in a PDP in the month the application was filed, and dies in that month, the application should be canceled.

In a couple’s case, if one member of the couple dies before the application is processed but the deceased spouse was enrolled in a PDP in the month of filing, a subsidy eligibility determination is required from the filing date month through the month of death. The deceased spouse’s income is used to determine the living spouse’s subsidy for the month of filing through the month of the deceased spouse’s death. If the deceased spouse was not enrolled in a PDP in the month of filing and subsequently dies in that month, an eligibility determination is not required. The couple’s application should be canceled and an individual application should be created for the living spouse. Since enrollment in a PDP could not occur before the next month, determining the deceased spouse’s LIS eligibility would not be necessary.

When verification is required:

  • Contact the third party, if one is named on the subsidy application to resolve the verification issue.

  • If the third party is unresponsive or unable to reconcile the discrepancy, contact the living with spouse, if one is named on the subsidy application.

  • If neither is named or the named third party/spouse cannot reconcile the discrepancy, use Agency data to make the determination.

Follow the procedures in HI 03035.006C. and HI 03035.006C.1. when contacting the third party and/or a living with spouse named on the application, with the exception of the last bullet in HI 03035.006C.2. Agency data will be used, if the contacts are unsuccessful or there is no one to contact.

EXCEPTION: A subsidy determination is not required if death occurred before:

  • 1/2006, or

  • The effective date of Part D enrollment. Policy - Subsequent Applications

F. Policy - subsequent applications

1. Definition

A subsequent application is an application that SSA receives after one was previously submitted and possibly processed for the same individual or couple. A subsequent application may be considered a duplicate application in certain situations but not all subsequent applications are duplicate applications. A true duplicate application situation will have separate applications and can be identified by two separate listings on the Query Sub Menu Screen (QSMS).

NOTE: You should always request a MAPS Query (MS 03301.009) before taking an application for Extra Help or responding to an inquiry.

CAUTION: A claimant cannot reapply for the subsidy for the purpose of having a subsidy determination reevaluated based on a change in the Federal Poverty Level (FPL). In fact, in some cases the higher FPL may not be to the claimant's advantage since a higher Title II amount would also be used. Therefore, if a subsequent application is filed, the application will be processed as a duplicate and Important Information Notice 2 sent to the claimant per instructions in HI 03010.010F.5.a.

2. Processing subsequent applications - both applications received by SSA

a. Disposition of subsequent paper applications received in the field office (FO)

When the FO receives a subsequent paper application, forward the application to WBDOC where it will be processed through the scanning operation. The address varies depending on the application received.

  • For SSA-1020 use:

    P.O. Box 1020 Wilkes-Barre, PA 18767-1020

  • For SSA-1026 use:

    P.O. Box 1080 Wilkes-Barre, PA 18767-1080

  • For SSA-1021 use:

    P.O. Box 1030 Wilkes-Barre, PA 18767-1030

  • For Request for Information use:

    P.O. Box 1077 Wilkes-Barre, PA 18767-1077

NOTE: If the FO receives paper applications that are not subsequent (i.e., it is the first application or appeal), the FO should enter these applications into MAPS.

b. Processing subsequent applications

The action needed on a subsequent application will depend on the circumstances as outlined in the following chart.

IMPORTANT: 

Effective January 1, 2024, all Extra Help beneficiaries receive full subsidy. A partial subsidy determination can only be made on an Extra Help case that has a coverage start date before January 1, 2024. To locate the coverage state date field in MAPS, see MS 03301.008C. [11-D]. For applications that have not been sent to subsidy determination, locate the field in MAPS that captures the estimated effective date, MS 03206.002E[21-D]. For information about MAPS determination dates, see MS 03206.021.

Existing partial subsidy beneficiaries do not need to file a new application or request an appeal to get IRA updates applied to their case.

Subsequent Application Chart

Current Subsidy Status

SCE Reported

Appeal Pending

Selected For Redet

Subsequent Application Type

System Action

FO/OCO Action

Award (full or partial)

No

No

No

SSA-1020

Send Important Information Notice 2 as described in HI 03010.010.F.5.a

No Action Necessary

Award (full or partial)

Yes

(pending re turn of 1026SCE)

No

N/A

(Not selected for Redet When SCE reported)

i1020

Identify app as duplicate and assign to l13(OEIO/SAU)

Review data to determine if applicant is reporting SCE via the i1020 in lieu of the 1026SCE. Take appropriate action to process SCE DIRCON if required (GN 01070.600)

Award (full or partial)

Yes

(pending return of 1026SCE)

No

N/A

(Not selected for Redet When SCE reported)

SSA-1020

1026SCE

Process as SCE

No Action Necessary

Award (full or partial)

No

Yes

No

SSA-1020

i1020

Identify app as duplicate and assign to l13(OEIO/SAU)

Per HI 03040.100.B.2, transfer the subs. app to the SAU. The SAU will use the info for decision, address the subs. app in the decision notice, and cancel the app.

Award (full or partial)

No

No

Yes

(L1026 was returned-waiting for return of 1026-REDE or Redet is AWAITING AGY DATA)

1020

Identify app as duplicate and assign to l13(OEIO/SAU)

Review data to determine if applicant is reporting Redet via the 1020 in lieu of the 1026 REDE. Take appropriate action to process redet. Use DIRCON if required.

Award (full or partial)

No

No

Yes

(SSA-1026 has been returned)

1026-REDE (no change in data from 1st 1026)

Identify app as HouseHold Exception and assign to Servicing FO

Review data to determine any differences in reported data and take appropriate action to process SCE or other event if there are changes. If no changes, treat as duplicate.

Award (full or partial)

No

No

Yes

(SSA-1026 has been returned)

1026-REDE (Change in data from1st 1026)

SD will process as SCE or Redetermination

Review data to determine any differences in reported data and take appropriate action to process the report of the changed information.

Award (full or partial)

No

No

Yes

1026SCE (or SCE is reported to FO or 800#)

Identify app as duplicate and assign to l13(OEIO/SAU)

Review data to determine what the applicant is reporting. DIRCON if required.

Denial

N/A

Yes

N/A

1020

Identify as dup and send to l13(OEIO/SAU)

Transfer app to SAU

Denial

N/A

No

N/A

1020

System will process as a new application.

N/A

Terminated

Yes

No

N/A

1026SCE

Identify as dup and send to l13

If within Appeal period, complete appeal screens and submit app to SAU. If outside Appeal period, submit as new app.

Transfer appl to SAU

 

Terminated

 

No

Yes

No

SSA-1020

Identify as DUP & send to l13(OEIO/SAU)

 

Initial application SD is PENDING

No

No

N/A

SSA-1020 or i1020

SD will mark application as a duplicate and will normally assign it to OEIO/SAU

NOTE: If a FO or SAU is processing a case with a pending duplicate application, that office should also process the dup. application.

Review and compare both applications to determine which application has the oldest application date since that application date must be used. Also, determine who filed each application (individual or third party).

If the alleged income or resources is higher on the individual's application or if the differences between the two applications are not Material (i.e., do not affect the subsidy percentage), process the application using the individual's alleged amounts.

If you cannot resolve the discrepancies by reviewing the applications, contact the individual to resolve them. Update the application that will be processed with information from the application that will be cancelled, as appropriate. See Edit/Cancel Application function chart (HI 03010.039.E.1 and .E.2) for appropriate action for editing and canceling applications.

3. Processing subsequent applications - one application is processed by SSA the other is processed by a State Medicaid Agency

If both SSA and a State Medicaid Agency process an application for the same person, CMS will determine which application is the official one based on the chart below. CMS will notify the beneficiary and each agency.

SSA determination was:

State determination was:

Outcome

Denial

Approval

Approval is official determination. Beneficiary may appeal either decision.

Approval

Denial

Approval is official determination. Beneficiary may appeal either decision.

Denial

Denial

The beneficiary may appeal either decision. If both are appealed and overturned, see the corresponding “approval” scenarios.

Approval (Different Month)

Approval (Different Month)

If the subsidy application dates are in different months, the decision on the earlier application is the official determination. The second decision is void.

Approval (Same Month)

 

Approval (Same Month)

 

If the subsidy application dates are in the same month, the SSA decision is the official determination. The beneficiary may appeal either decision.

Pending

Approval

The system compares the applications. If the SSA application has the same application date as an approved State application or has an earlier date, SSA will continue processing the application. If the State application has an earlier application date, SSA will discontinue processing the application and issue the notice described in the third bullet in HI 03010.010F.5.a. in this section.

4. Processing cases when an incorrect SSN was previously used and the NH for that SSN now wants to file an application

These instructions refer to cases where an incorrect SSN was used on an application for a spouse and that application has been processed. The individual that the SSN belongs to contacts SSA and wishes to file an application, however, the original incorrect application is still within the appeals period.

a. First application was denied

Load the new application using the correct SSN and protective filing date, and process as usual.

b. First application was allowed

If the error is discovered within 60 days of receipt of the favorable initial determination or fully favorable hearing decision, follow the instructions in HI 03050.045C for correcting errors using the manual correction process.

5. Notices

a. Notices used for processing subsequent applications

The following notices will be used for processing subsequent applications. Important Information Notices 1 and 3 are available on DPS titled "Medicare Subsidy Duplicate Application" under the DPS General Category tab, but Important Information Notice 2 is generated by MAPS and is not available on DPS:

  • Important Information Notice 1 advises the individual that we have received a subsequent application from a third party but we will not process it. The individual will be told to contact the 800# if the individual was attempting to appeal. See HI 03094.610 for an exhibit of this notice.

  • Important Information Notice 2 advises the individual that the determination on the first application remains in effect for 12 months unless the individual reports a subsidy changing event. See HI 03094.615 for an exhibit of this notice.

  • Important Information Notice 3 advises the individual that we have received a duplicate application which we will not process. See HI 03094.620 for an exhibit of this notice.

b. Required Action if the person calls as a result of the above notices

  • If the person wants to file an appeal, complete the appeal screens in MAPS.

  • If the person was trying to report a subsidy changing event (per HI 03050.025) or was reporting a non-subsidy changing event between August 1 and December 31 of any year, review the second application. If the change is on the form, refer to an adjudicator to make the change. Do not send another SSA-1020.

  • If the person was trying to report an event which is not a subsidy changing event between January 1 and July 31 of any year, advise the person that we will send notification after August of the current year for a redetermination. Annotate the system to indicate a report was made per HI 03050.025. If the report affects other program benefits that the claimant receives, take the appropriate action.


HI 03010 TN 48 - Applications - 2/01/2024