Income limit is approximately 150% FPL and resource limit is $17,220 (individual) / $34,360 (couple) — these amounts are updated annually

Your primary home, car, burial plots, and up to $1,500 in burial funds do NOT count as resources

If denied by SSA, you can apply to your state Medicaid agency for a Medicare Savings Program, which may auto-qualify you for Extra Help

Financial Assistancemoderate

Extra Help / Low-Income Subsidy (LIS) Application

SSA-1020 · Social Security Administration

Application for Extra Help (Low-Income Subsidy) with Medicare Part D prescription drug costs. Reduces premiums, deductibles, and copayments for qualifying beneficiaries. Can save an average of $5,300 per year.

Form Details

Total fields: 40
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Where to Submit This Form

🌐

Apply online at SSA.gov

https://www.ssa.gov/medicare/part-d-extra-help

Fastest method. Apply online through your my Social Security account.

📬

Mail SSA Form SSA-1020 to your local Social Security office

https://www.ssa.gov/forms/ssa-1020.pdf

🏢

Call Social Security at 1-800-772-1213

Available 8 AM - 7 PM local time, Monday through Friday.

🏢

Apply in person at your local Social Security office

https://www.ssa.gov/locator/

Filing Deadline

Apply at any time. Benefits begin the month after approval. If auto-enrolled in a Part D plan, Extra Help applies immediately.

Required Attachments

📎 SSA Form SSA-1020 (Application for Extra Help with Medicare Prescription Drug Plan Costs)
📎 Information about income (wages, pensions, Social Security, interest, dividends)
📎 Information about resources (bank accounts, investments, real estate other than primary home)
📎 No documentation required at application — SSA verifies electronically

Processing Time

2-4 weeks. SSA verifies income and resources electronically. You will receive a notice of approval or denial.

What Happens Next

If approved, you will receive significantly reduced Part D premiums, deductibles, and copays. If you are not already enrolled in a Part D plan, you will be auto-enrolled in one. You can change Part D plans at any time during the year.

Tips for This Form

✓ Income limit is approximately 150% FPL and resource limit is $17,220 (individual) / $34,360 (couple) — these amounts are updated annually
✓ Your primary home, car, burial plots, and up to $1,500 in burial funds do NOT count as resources
✓ If denied by SSA, you can apply to your state Medicaid agency for a Medicare Savings Program, which may auto-qualify you for Extra Help
✓ Extra Help saves an average of $5,000 per year on prescription drug costs

More Financial Assistance Forms

Patient Assistance Program Enrollment

PAP Enrollment (manufacturer-specific) · Pharmaceutical Manufacturers (Pfizer, Lilly, Merck, J&J, AbbVie, etc.)

Application for free or reduced-cost medications for uninsured or underinsured patients. Requires income documentation and prescriber attestation. Each manufacturer has its own form and eligibility criteria.

Manufacturer Copay Card / Coupon Enrollment

Copay Card (manufacturer-specific) · Pharmaceutical Manufacturers

Enrollment for manufacturer copay reduction programs for commercially insured patients. NOT available to Medicare, Medicaid, or other federal program beneficiaries. Some insurers have accumulator adjustment programs that prevent copay card amounts from counting toward deductible.

340B OPAIS Registration

340B OPAIS · HRSA Office of Pharmacy Affairs

Online registration in the 340B Office of Pharmacy Affairs Information System. Required for covered entities (FQHCs, hospitals, etc.) before purchasing 340B-priced drugs. Requires supporting documentation for hospital classification.

340B Annual Recertification

340B Recertification · HRSA

Annual recertification of eligibility to participate in the 340B program. Failure to complete results in program termination. Authorizing Official must verify compliance with all program requirements.

State Pharmaceutical Assistance Program Application

SPAP Application (state-specific, e.g., NJ PAAD, NY EPIC, PA PACE) · State Pharmaceutical Assistance Programs

Application for state-funded prescription drug assistance. Eligibility typically based on age, income, and residency. Available in 20+ states. May coordinate with Medicare Part D for additional savings.

PAP Attestation Form (CMS)

PAP Attestation · CMS

Attestation that the Patient Assistance Program operates outside the Part D benefit to ensure separateness. PAP assistance does not count toward True Out-of-Pocket costs (TrOOP).

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Disclaimer: BeneFill™ provides form-filling assistance and informational guidance only. It is not affiliated with, endorsed by, or sponsored by the Social Security Administration or any government agency. The information provided is for general informational purposes and does not constitute legal, medical, financial, or tax advice. Always verify form requirements and submission details directly with the issuing agency.