Data about Extra Help with Medicare Prescription Drug Plan Cost

Last updated on October 10, 2014

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This dataset contains fiscal year data and is currently available in the following formats:

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Background

The Social Security Administration (SSA) takes Medicare applications and provides Medicare information to the American public.  The agency has a specific role in the Medicare Prescription Drug Program (Part D).  Social Security takes and decides applications for Extra Help with Medicare Prescription Drug Plan Cost, a provision to subsidize costs for Part D prescription drug plans for qualifying low income applicants. Other individuals automatically qualify (or are “deemed”) for Extra Help with Medicare Prescription Drug plan costs because they also have Medicaid or receive Supplemental Security Income (SSI) benefits.

This documentation describes a publicly available dataset about Social Security determinations of eligibility for Extra Help with Medicare Prescription Drug Plan Costs. The dataset includes annual data at the state level from federal FY 2010 onward of Social Security Administration Extra Help decisions. Specific data elements are counts of Extra Help decisions made, counts of applicants found eligible for the Extra Help, and a percentage of Extra Help decisions found eligible by state.   The dataset does not include counts of individuals automatically qualified (or “deemed”) for Extra Help or individuals who applied for Extra Help through a State Medicaid agency.

Index:

Agency Program Description

Medicare is our country’s health insurance program for people age 65 or older. Certain people younger than age 65 can qualify for Medicare, too, including those who have disabilities, permanent kidney failure or amyotrophic lateral sclerosis (Lou Gehrig’s disease). The program helps with the cost of health care, but it does not cover all medical expenses or the cost of most long-term care.

Medicare is financed by a portion of the payroll taxes paid by workers and their employers. It also is financed in part by monthly premiums deducted from Social Security checks.

The Centers for Medicare & Medicaid Services in the Department of Health and Human Services is the agency in charge of the Medicare program. For complete information about Medicare go www.cms.gov. But you apply for Medicare at Social Security, and we can give you general information about the Medicare program. 

Medicare has four parts:
  • Hospital Insurance (Part A) helps pay for inpatient care in a hospital or skilled nursing facility (following a hospital stay), some home health care and hospice care.
  • Medical Insurance (Part B) helps pay for doctors’ services and many other medical services and supplies that are not covered by hospital insurance.
  • Medicare Advantage plans (Part C) are available in many areas. People with Parts A and B can choose to receive all of their health care services through a provider organization under Part C.
  • Prescription drug coverage (Part D) helps pay for medications doctors prescribe for treatment.

Medicare beneficiaries can qualify for Extra Help with their Medicare prescription drug plan (Part D) costs. The Extra Help is estimated to be worth about $4,000 per year. To qualify for the Extra Help, a person must be receiving Medicare, have limited resources and income, and reside in one of the 50 States or the District of Columbia.  Medicare beneficiaries can automatically qualify for Extra Help if they also receive any type of Medicaid assistance from their State or get Supplemental Security Income (SSI) benefits.  Medicare beneficiaries can also apply for Extra Help, by completing Social Security's Application for Extra Help with Medicare Prescription Drug Plan Costs (SSA-1020). You can apply online at www.socialsecurity.gov/extrahelp; call Social Security at 1-800-772-1213 (TTY 1-800-325-0778) to apply over the phone or to request an application; or apply at your local Social Security office.

Dataset Description

This dataset provides annual data at the national and state levels from federal fiscal year 2010 onwards of Social Security Administration decisions for Extra Help with Medicare Prescription Drug Plan costs (Part D). Percentage of eligible applications is derived by dividing the number of individuals found eligible for Extra Help With Medicare Prescription Drug Plan Cost applications by the total number of decisions made on Extra Help With Medicare Prescription Drug Plan Costs by SSA.      (NOTE: This dataset does not include individuals who applied for Extra Help through a State Medicaid agency or who automatically qualified for Extra Help because they receive Medicaid assistance or SSI benefits.)

Data Collection Description

The information for the dataset is a result of information keyed into web applications either by the public/applicant or by an agency employee.   The source of the dataset is the Social Security Unified Measurement System (SUMS) Counts Data Warehouse.  The data is updated daily with the most current SUMS Workload data from the Medicare Operational Data Store.

Data Dictionary

Field A: Geographic Area, indicates the state (or one other location which is the District of Columbia and is shown in the table as DC) provided as the applicant’s address.  Locations other than the fifty states and DC are shown as “no zip available”.

Field B: Decisions Made, indicates the number of decisions made on Extra Help With Medicare Prescription Drug Plan Cost applications by the Social Security Administration.

Field C: Eligible, indicates the number of applicants found eligible after submitting an application for Extra Help With Medicare Prescription Drug Plan Cost.

Field D: Percentage Eligible, Field C divided by Field B expressed as a percentage.  This is the percentage of applicants eligible for Extra Help With Medicare Prescription Drug Plan Cost after filing an application with Social Security.