Social Security
Administration
Medicare
Prescription Drug Assistance
Notice of Hearing Decision
SDS return address
Date: April
20, 2006
Social Security
Number: 123-00-6789
JOHN Q. PUBLIC
123 MAIN ST
SPRINGFIELD OH 45501
On a request for appeal filed March 25, 2006, you asked us to review the determination
we made on your Application for Help with Medicare Prescription Drug Plan Costs. This
notice tells you our decision, the reason for our decision, and the effect our decision
has on your right to further review.
History
Your claim was previously denied on March 10, 2006. A hearing was held on April 20,
2006. You participated in the hearing along with John Smith.
Issue
The issue(s) in this case is whether you have countable income that is 150% or more
of the Federal Poverty Level.
Facts
You submitted and I reviewed a letter from Sunshine Printing Incorporated which stated
your pension is currently $11,000 per year. This amount added to your Social Security
benefits of $3,269 puts you over the income limit of $12,000 prescribed by law. Attached
is a list of exhibits.
The Decision
You are not eligible for extra help to pay your Medicare prescription drug plan costs,
also known as subsidy, because your income is over the income limit.
Authority
The new law on the Medicare prescription drug programs provides that the income and
resource limits for eligibility for the Medicare Prescription Drug subsidy be based
on our Supplemental Security Income (SSI) rules. I followed those rules in making
this decision. You have the right to review and get copies of the information in our
records that we used to make the decision explained in this letter. You also have
a right to review and copy the laws, regulations and policy statements used in deciding
your case. To do so, please contact us at 1-800-772-1213.
This Decision Is Final
If you disagree with the decision, you may ask for court review by filing a civil
action. If you do not ask for court review, this decision will be final.
How To File A Civil Action
You may file a civil action (ask for court review) by filing a complaint in the United
States District Court for the judicial district in which you live. The complaint should
name the Commissioner of Social Security as the defendant and should include the Social
Security number(s) shown at the top of this letter.
You or your representative must deliver copies of your complaint and of the summons
issued by the court to the U.S. Attorney for the judicial district where you file
your complaint, as provided in rule 4(i) of the Federal Rules of Civil Procedure.
You or your representative must also send copies of the complaint and summons, by
certified or registered mail, to:
The General Counsel
Social Security Administration
Room 611 Altmeyer Building
6401 Security Boulevard
Baltimore, MD 21235
And:
The Attorney General of the United States
Washington, DC 20530
Time To File A Civil Action
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•
You have 60 days to file a civil action (ask for court review).
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•
The 60 days start the day after you receive this letter. We assume you received this
letter 5 days after the date on it unless you show us that you did not receive it
within the 5-day period.
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•
If you cannot file for court review within 60 days, you may ask us to extend your
time to file. You must have a good reason for waiting more than 60 days. You must
make the request in writing and give your reason(s) in the request.
You must mail your request for more time to us at the address shown at the top of
this notice. Please put the Social Security number(s) also shown at the top of this
notice on your request. We will send you a letter telling you whether your request
for more time has been granted.
How To Sign Up For A Medicare Prescription Drug Plan
You do not need to receive this extra help paying for the costs related to your Medicare
prescription drug plan in order to be eligible to enroll in a Medicare prescription
drug plan or Medicare Advantage drug plan. You can enroll beginning November 15, 2005.
For more information about the prescription drug plans available in your area, go
to 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.
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 Reviewer
Enclosure
List of Exhibits