Public Law
108-173, the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (MMA),
requires the Social Security Administration (SSA) to periodically review a beneficiary’s
continuing eligibility for Medicare Part D Extra Help and the amount of Extra Help
(also known as low-income subsidy, LIS, or subsidy).
Each year in August, SSA systems select beneficiaries who receive Extra Help and meet
the criteria for an Extra Help redetermination. SSA mails these beneficiaries an SSA-1026-OCR-SM-REDE (Social Security Administration Review Of Your Eligibility For Extra Help).
SSA mails Extra Help beneficiaries who experience a Subsidy-Changing Event (SCE) an
SSA-1026-OCR-SM-SCE .
We instruct beneficiaries to complete the SSA-1026 form and return it to the Wilkes-Barre
Direct Operations Center (WBDOC) for processing. For additional information regarding
timeframes for returning an SSA-1026 form see HI 03050.025B.2. and HI 03050.030D.
A change in income, resources, or household composition can affect a beneficiary’s
eligibility for Extra Help and the subsidy eligibility.
The Inflation Reduction Act (IRA) provides full subsidy to all eligible Extra Help
beneficiaries who have a coverage start date on or after January 1, 2024. To locate
the coverage start 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 (see MS 03206.002E [21-D]).