Form SSA-1020-OCR-SM Application for Help With Medicare Prescription Drug Plan Costs

Form SSA-1020-OCR-SM Application for Help With Medicare Prescription Drug Plan Costs

What Is Form SSA-1020?

Form SSA-1020-OCR-SM, Application for Help with Medicare Prescription Drug Plan Costs, is a form used to apply for the Extra Help Program. The Extra Help Program is designed to help people with limited income and resources to pay their prescription drug costs.

Alternate Names:

  • Form SSA-1020;
  • SSA Form 1020-OCR-SM.

The form was last released by the U.S. Social Security Administration (SSA) on January 1, 2019. Download Form SSA-1020 through the link below.

Form SSA-1020 Instructions

A related form - Form SSA-1020-INST, General Instructions for Completing the Application for Extra Help with Medicare Prescription Drug Plan Costs - contains information about the eligibility criteria for the Extra Help Program and instructions on completing the SSA-1020 application form.

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How to Apply for Extra Help with Medicare Prescription Drug Plan Costs?

  1. If you meet the Extra Help eligibility criteria, you can apply for the program using Form SSA-1020. These criteria include income and resource limitations. Also, you must reside in one of the 50 States or the District of Columbia.
  2. If your yearly income does not exceed $18,210 and your countable resources do not exceed $14,100. For married couples, the limits are $24,690 for income and $28,150 for resources. Countable resources include money in bank accounts, stocks, and bounds. Real estate, one car, burial plot and burial expenses up to $1,500, furniture, and other personal items are not included.
  3. Extra Help covers not more than $8.50 for each brand-name drug and $3.40 for each generic drug.

Patients who have full Medicaid coverage receive Supplemental Security Income (SSI) benefits or get help from their state Medicaid program paying their Plan B premiums, automatically qualify for Extra Help. In this case, there is no need to file the SSA-1020 application.

The eligibility criteria for the Extra Help Program change each year and if you qualify for the current year, you might not qualify for the next. In this case, a notice will be sent to you. If you are not qualified automatically anymore, a notice will be sent in September and printed on grey paper. If you received a notice printed on orange paper in October, that means your copayment amounts will change in the next year.

There are three ways to apply for the Extra Help Program:

  1. The application process can be done online via the Social Security Administration (SSA) website. The website will provide you with a Reentry number. It is possible to go back to the application if you do not fill it all at once. Before you submit an application, you can edit the information you entered. Also, the online application is time-sensitive. After you spend 25 minutes on one page you will receive a warning. The third warning will force you to move to the next page or end your session and lose all information.
  2. If you do not want or cannot file an online application, you can visit your local Social Security office and apply in person. Alternatively, you can call Social Security at +1 (800) 771-1213 (TTY +1 (800) 325-0778) to apply over the phone or request a copy of Form SSA-1020 to be mailed to you.
  3. If you decided to file a paper application form, complete it according to the instructions in Form SSA-1020-INST. Place the Form SSA-1020 in an envelope. Do not include anything else. The SSA will contact you for additional information, if necessary. Mail the application form to the following address: Social Security Administration, Wilkes-Barre Direct Operations Center, P.O. Box 1020, Wilkes-Barre, Philadelphia 18767-9910

Download Form SSA-1020-OCR-SM Application for Help With Medicare Prescription Drug Plan Costs

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