TN 23 (01-24)

HI 03050.015 Adjustments and Terminations

A. INTRODUCTION

There are no mandatory reporting rules in the Extra Help program. An Extra Help beneficiary or any person, company, or agency may contact SSA to report a change in income, resources, or household composition. This section explains the effect of eligibility changes in Medicare Part D Extra Help (low-income subsidy or LIS) eligibility.

Starting January 1, 2024, the Inflation Reduction Act (IRA) provides full subsidy to all eligible Extra Help beneficiaries. Extra Help applications that have a coverage start date before January 1, 2024 may result in a partial subsidy award. To locate the coverage start date field in MAPS, see MS 03301.008C [11-D]. For applications that have not been set to subsidy determination, locate the field in MAPS that captures estimated effective date, see MS 03206.002.E [21-D].

 

NOTE: 

This section does not explain how to evaluate Extra Help program reports of change. Those instructions appear in HI 03050.025. For instructions on how to correct technician identified errors within 60 days of initial determination or hearing, see HI 03050.045.

B. POLICY

1. Subsidy-Changing Events

Certain changes in an individual’s circumstances could increase or reduce a subsidy amount or terminate eligibility for a subsidy. The six subsidy-changing events are listed in HI 03050.025.

NOTE: 

Starting January 1, 2024, the Inflation Reduction Act (IRA) provides full subsidy to all eligible Extra Help beneficiaries. Extra Help applications that have a coverage start date before January 1, 2024 may result in a partial subsidy award. To locate the coverage start date field in MAPS, see MS 03301.008C [11-D]. For applications that have not been set to subsidy determination, locate the field in MAPS that captures estimated effective date, see MS 03206.002.E [21-D].

2. Increase in Subsidy

An increase in a subsidy amount means that an individual would be able to pay a lower premium to participate in the Medicare Part D program. An increase in subsidy may also result in a reduction in or elimination of any deductible. In certain situations, an increase in a subsidy amount may result in a reduced copayment for covered prescription drugs for which an individual is responsible.

3. Reduction in Subsidy

A reduction in a subsidy means that an individual would have to begin to pay a premium or a higher premium to participate in the Medicare Part D program. The individual may also have to begin to pay a deductible and in some cases a higher copayment for covered prescription drugs.

4. Termination of Subsidy

A termination means that an individual would no longer be eligible for a subsidy under the Medicare Part D program.

NOTE: After a termination, an individual must generally file a new application (absent a favorable appeal decision) and meet the requirements in HI 03001.020 to qualify for a subsidy. See an exception in HI 03010.005D for an individual who subsequently qualifies as a deemed eligible person.

5. Effective Dates

Adjustments and terminations will be effective beginning in January of the next calendar year following a periodic redetermination or the month after the month of the report of a change that is a subsidy changing event as defined in HI 03050.025. Individuals must receive an advance written notice of intent with the effective date of the adjustment or termination which includes their appeal rights. Appeal rights for a reduction or termination will include the right to continue to receive a subsidy at the established level until there is a decision on the appeal. These procedures are explained in detail in HI 03040.001.

C. REFERENCES

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

  • HI 03010.005 Interviewing for Medicare Part D Extra Help

  • HI 03040.001 Overview of Appeals Process for Medicare Part D Subsidy

HI 03050.000 Redeterminations


To Link to this section - Use this URL:
http://policy.ssa.gov/poms.nsf/lnx/0603050015
HI 03050.015 - Adjustments and Terminations - 01/31/2024
Batch run: 10/03/2024
Rev:01/31/2024