Medicare Changes and Social Security

The Medicare Improvements for Patients and Providers Act (P.L. 110-275) changed existing Medicare law to further assist low-income beneficiaries:

Social Security is now working with the States to increase participation in Medicare Savings Programs. For information on our expanded role, see our fact sheet.

As of January 1, 2010, it became easier for some people to qualify for Extra Help with their Medicare prescription drug plan costs. For more details, see our fact sheet.

SSA is reaching out to certain Medicare beneficiaries who were previously ineligible for Extra Help. According to our records, these beneficiaries applied for the assistance, but were denied due to the value of non-cash support (as income) or the cash value of life insurance policies (as a resource). With the changes in eligibility effective January 1, 2010, these beneficiaries could potentially receive extra assistance with Medicare Part D costs.

Around 2.5 million beneficiaries across the country have received an Informational notice regarding Extra Help eligibility. The notice also provides information about how to apply at field offices or over the Internet.

Effective January 1, 2006, a new Medicare Prescription Drug Program, also referred to as Medicare Part D, was launched. In addition to the prescription drug insurance the program makes available to all Medicare beneficiaries, the program also provides subsidies – or “extra help”-- for those Medicare beneficiaries who have limited income and resources. These subsidies reduce out of pocket costs paid by those Prescription Drug Program (PDP) enrollees who have limited income (below 150% of the poverty line applicable to the size of the family involved) and resources (up to $12,510 in assets for an individual or $25,010 for a married couple in 2010) by providing reduced monthly premiums and other cost-sharing assistance.

Social Security provides additional outreach resources for individuals and organizations working to assist the public with the prescription drug “extra help” program (also known as the Medicare Part D Subsidy). This link contains an online tool that can be used to assess an individual’s potential eligibility for a subsidy, as well as copies of outreach posters, and additional training materials.

During May and June 2009, SSA mailed around 5 million outreach letters to Medicare beneficiaries who are potentially eligible for Medicare Savings Programs (MSPs) or the Part D Low-Income Subsidy (extra help). This annual outreach, stipulated under Section 1144 of the Social Security Act, requires SSA to notify low-income Medicare beneficiaries each year about specific programs available to assist them with their medical and prescription drug expenses. The Centers for Medicare and Medicaid Services (CMS) joins SSA in this effort, with both SSA and CMS letterhead appearing on all notices.

The following links show three versions of the 2009 outreach letters:

* SSA-L446 – Mailed to beneficiaries whose countable income appears too high for the Medicare Savings Programs but not too high for Extra Help.

* SSA-L447 – Mailed to beneficiaries with countable income that appears to be less than 135% of the Federal Poverty Level; the beneficiaries have Extra Help but do not have a Medicare Savings Program.

* SSA-L448 – Mailed to beneficiaries with countable income that appears to qualify them for Extra Help and the Medicare Savings Programs but the beneficiaries have neither.