If the denies your Extra Help Extra Help, also known as the Part D Low-Income Subsidy (LIS), is a federal program administered by Social Security that helps pay for some to most of the out-of-pocket costs of Medicare prescription drug coverage, including coinsurances, deductibles, and premiums. People with Medicare who have income and assets below specified limits are eligible for Extra Help, which has different levels. Depending on your income and assets, you may qualify for either full Extra Help or partial Extra Help. People may also be automatically enrolled in Extra Help if they have certain other types of coverage, even if their income and assets are above the set levels. Â application and you disagree, you have two opportunities to request that your case be reexamined.
1. Before the final decision
- If your application is going to be denied, you will receive a Pre-Decisional Notice before being formally denied. The Pre-Decisional Notice explains that you may not be eligible for Extra Help and why you will be denied (for example, the monthly income you reported in your application is over the limit). If you think that SSA’s rejection is based on incorrect information, you can correct your application.
- You have 10 days from the date on the notice to make corrections. It may be fastest to call or visit your local SSA field office using the telephone number or address on the notice. You can also call SSA’s national hotline at 800-772-1213.
2. After the final decision
Once SSA makes a final decision, you will receive either a Notice of Award or a Notice of Denial, meaning you do not qualify. If you disagree with SSA’s decision, you can appeal An appeal is a formal request for review if you disagree with an official health care coverage or payment decision made by a Medicare Advantage Plan, a Medicare private drug plan (Part D), or Original Medicare. Federal regulations and law specify appeals deadlines, processes for handling appeals, what information must be included in a decision, and the levels of review in the appeals process. . It is better to appeal than to reapply. This is because if your appeal is successful, your Extra Help will be effective from the first day of the month that you originally submitted an application.
Appeal process
- Request a hearing within 60 days of receiving notice of SSA’s decision. Note: If you have a good reason for missing your appeal deadline, you may be eligible for a good cause extension.
- If you do not want a hearing, you can request a case review where an SSA agent will review your application and any additional information you send in.
- Set a date for a hearing by calling your local SSA office or the national hotline at 800-772-1213. You can also download an online form and mail it to request a hearing. Generally, SSA will suggest a date at least 20 days after your request, giving you time to prepare. However, you can waive the 20-day preparation period if you want your hearing to be held sooner.
- Participate in your hearing. Hearings are held by phone. You will get a notice in the mail that confirms the date of your hearing and gives you a toll-free number to call. This notice also explains how to submit evidence supporting your case (for example, bank statements that show your assets Assets are resources such as savings and checking accounts, stocks, bonds, mutual funds, retirement accounts, and real estate. ). If you have a scheduling conflict, you can reschedule your hearing if you have good cause.
- After your hearing or review, SSA will send you a notice with the final decision on your case. If you still disagree with the decision, you can file an appeal in Federal District Court The Federal District Court is the final level of the Medicare appeals process, following an unfavorable decision at the Medicare Appeals Council level. .