In August of every year, SSA systems identify initial Extra Help awards and randomly selects cases for initial redeterminations. The selection criteria includes beneficiaries, both individuals and couples, who became eligible from May of the prior year through April of the selection year.

Example: The initial redetermination process completed in August 2023 are selected from beneficiaries who became eligible from May 2022 through April 2023. The System selects these beneficiaries for an initial redetermination if the beneficiaries have not already had a subsidy-changing event (SCE) or Other Event reported between May and December of 2022. SSA uses agency data in all cases.

Example: Beneficiaries selected for an initial redetermination will receive an SSA-1026-OCR-SM-REDE (Social Security Administration Review Of Your Eligibility For Extra Help). The selection criteria include:

1. 1. 

   Cases where agency data indicate a potential change in Extra Help;

2. 2. 

   Beneficiaries who reported an Other Event between January and the redetermination selection date in August;

3. 3. 

   Beneficiaries who did not respond to an Office of Quality Review (OQR) report finding during the review period;

4. 4. 

   Beneficiaries whose records had errors OQR found during the OQR review;

5. 5. 

   Members of a couple who have different Extra Help filing dates, different Extra Help eligibility determinations, or a spouse who reported an SCE; and

6. 6. 

   Cases that fall into the category of special outreach, if any, for the year.

   NOTE: 

   On August 16, 2022, the President signed the Inflation Reduction Act (IRA) of 2022, Public Law 17-169. Section 11404 expands full subsidy eligibility and ends what is currently known as partial subsidy eligibility. Starting January 1, 2024, only subsidy cases with subsidy determination effective dates before January 1, 2024 can receive partial subsidy awards. For applications that have not been sent to subsidy determination, locate the field in MAPS that captures the estimated effective date, see MS 03206.002E.[21-D].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.

SSA selects cyclical redeterminations annually in August.

The selection for cyclical redetermination include:

1. 1. 

   Extra Help-eligible beneficiaries who are more likely to have a change in the Extra Help eligibility, e.g., cases where agency data indicates a potential change in subsidy;

2. 2. 

   Members of a couple with different Extra Help filing dates or different Extra Help eligibility determinations;

3. 3. 

   Beneficiaries that reported an Other Event;

4. 4. 

   Surviving spouses;

5. 5. 

   Beneficiaries who did not respond to an OQR finding during the review period; and

6. 6. 

   Beneficiaries for whom OQR found errors on the record during the OQR report findings.

SSA redetermination selections exclude anyone who CMS deems eligible for Extra Help, previously reported an SCE, or had a no error OQR result.

If the System selects both members of a couple for a redetermination:

• •

  SSA mails only one SSA-1026-OCR-SM-REDE.

• •

  If one member of a couple returns the SSA-1026-OCR-SM-REDE and the information on the form does not match the information already in the System, the Medicare Application Processing System (MAPS) will generate an exception to the servicing field office (FO). To process this action, use Question 3 (Change in marital status) instructions in HI 03050.040B.

NOTE: Since the System selected both members of the couple on one application, we close the pending redetermination (based on that one application) so that the person who returned the redetermination form can continue to process any type of future applications. The System will convert the one who returned the SSA-1026-REDE form, to an SCE report and the one member will have a subsidy based on the SCE.

• •

  The REDET extension on the Development Worksheet screen (DWMP) will close with a report date equal to the receipt of the application.

• •

  If the other member of the couple (who did not return the SSA-1026-REDE form) does not report an SCE, or if we do not receive an SCE report from Medicare Miscellaneous Update Data Exchange (MUDEX) or the Railroad Board (RRB) data exchange, the member will continue the current subsidy determination until the next redetermination cycle or report of an SCE.

NOTE: SSA mails an SSA-1026-OCR-SM-SCE form to the surviving spouse if we identify a death during the redetermination selection process and an SSA-1026-OCR-SM-SCE has not yet been mailed. In situations where one member of the couple died between redetermination selection and the processing of the returned SSA-1026-REDE, MAPS will generate a household composition exception to the FO stating: “MBR indicates applicant is deceased” or “MBR indicates spouse is deceased.” The exception language is based on which member of a couple is deceased. For FO instructions in this situation, see HI 03050.025C.5. and HI 03050.025C.6.

Beneficiaries are required to complete the SSA-1026-OCR-SM-REDE form and return it to WBDOC within 30 days. The beneficiary may contact SSA within the 30-day period to request a one-time extension, not to exceed 30 days.

In mid-November, the vendor who handles the Medicare Reminder System (MRS) makes follow-up telephone calls to beneficiaries who failed to return the SSA-1026 on time and reminds them to complete and return the SSA-1026 (Statement for Continuing Eligibility for Extra Help with Medicare Prescription Drug Plan Costs) in order to retain eligibility for the Extra Help.

The SSA-2708 contains language requesting the beneficiary to contact the servicing FO by the end of January to complete a redetermination for Medicare Part D Extra Help. The SSA-2708 also provides:

1. a. 

   Information about interpreter services;

2. b. 

   Information about SSA’s toll-free number and TTY services; and

3. c. 

   The telephone number and address of their servicing FO.

If you receive an inquiry from a beneficiary regarding the Extra Help redetermination form, follow the instructions in TC 24020.090.

If the beneficiary completes a new Extra Help SSA-1020 (Application for Extra Help with Medicare Prescription Drug Plan Costs) instead of form SSA-1026 (Statement for Continuing Eligibility for Extra Help with Medicare Prescription Drug Plan Costs), MAPS software will allow the processing of form SSA-1020.

Beneficiaries can still complete form SSA-1026 through March 31^st.

• •

  HI 03035.000 Verification Process and Pre-Decisional Issues

• •

  HI 03050.020 Redetermination of Eligibility for Medicare Part D Extra Help (Low-income Subsidy)

• •

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

• •

  HI 03050.035 Extra Help Redetermination Forms

• •

  HI 03050.040 Exception Processing for Form SSA-1026 Questions

• •

  HI 03050.045 Manual Correction Process for the Extra Help Application

• •

  TC 24020.090 Subsidy Redeterminations