Social Security

Forms

• Instructions for the Application for Extra Help with Medicare Prescription Drug Plan Costs,(SSA-1020-INST). The instructions are only guidelines and not to be used as applications.



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• Apply for Extra Help online (SSA-i1020) (available in English only) or you can call Social Security at 1-800-772-1213 (TTY 1-800-325-0778) to apply over the phone or to request an original paper application (paper applications are available in English and Español), or you can apply at your local Social Security office.
  
  
• Appeal of Determination for Extra Help with Medicare Prescription Drug Plan Costs,(SSA-1021). To appeal the decision we made about your eligibility for Extra Help with Medicare prescription drug plan costs. (Español)



• Social Security Administration Review of Your Eligibility for Extra Help, (SSA-1026B). To review your continuing eligibility for Extra Help with Medicare prescription drug plan costs. (Español)

Publications

• Publications on Extra Help with Medicare prescription drug plan costs
  
  
• Publications in alternative media (English)–(Español)