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pdfSocial Security Administration
Extra Help with Medicare Prescription Drug Plan Costs
Notice of Denial
Southeastern
1200
Rev.
Birmingham,
Date:
Program
Abraham
AL
January
Service
Woods,
Center
Jr.
Blvd.
35285-0001
5
2021
BNC#:
DAFDFAAAFFDTTDAATDTDAAFDFDDADFFFDFTFADFTADFFTDDTTFTTATFAATDTFAFDT
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1-800-772-1213
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for
information
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eligible
determination
for
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(1-800-633-4227).
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www.medicare.gov
1-800-MEDICARE
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1-877-486-2048.
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count
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support
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married
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of
their
spouse.
following
(before
yearly
any
income:
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premium
deductions)
of
$27,494.40
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1-800-772-1213.
days
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appeal,
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$8,400.00
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at
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$1,326.00
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www.socialsecurity.gov/mediinfo.htm
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apply
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http://oig.ssa.gov/r
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about
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or
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General's
Fraud
Hotline
1-866-501-2101).
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information
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share
costs.
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1-800-325-0778.
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plans,
visit
1-800-MEDICARE
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you
can
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the
Medicare
1-877-486-2048.
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of
can
web
are
at
www.socialsecurity.gov
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away.
(1-800-633-4227).
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(1-800-633-4227).
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representative
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1-800-269-0271
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or
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benefits.
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application
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telephone
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can
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your
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call
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of
appeal.
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representative,
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groups
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answer
please
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you
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visit
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questions
our
website
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TTY
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at
1-800-772-1213.
number
phone.
toll-free
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at
Page
You
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also
can
area
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write
or
located
visit
any
Social
830
Telephone:
you
do
answer
call
or
your
visit
Income
Worksheet
Resource
an
office,
questions.
Enclosure(s):
Worksheet
The
office
that
6
serves
SECURITY
FLORENCE
CONCORD
us
office.
of
at:
SOCIAL
If
Security
4
NC
ST
NW
28027
1-888-456-9312
please
have
this
letter
with
you.
It
will
help
Page
SOCIAL
How
We
SECURITY
Counted
To
Pensions
Other
Income
General
Subtotal
Total
December
Your
Your
2020
Spouse's
Income
Subsidy
and
continuing
Security
Other
($240
And
Determine
For
Social
Your
ADMINISTRATION
of
or
Annuities
Income
Your
Limit
8,400.00
8,400.00
Income
Income
$27,494.40
Income
We
For
Exclusion)
We
Count
Count
Subsidy
(
240.00)
$44,054.40
$44,054.40
Eligibility
$32,580.00
5
of
6
Page
SOCIAL
How
We
SECURITY
Counted
To
For
Bank
Fund
Amount
Money
Limit
Over
counted
your
Your
Your
2020
Spouse's
Resources
Subsidy
and
continuing
$6,391.00
Resources
Resource
We
And
December
home,
Because
only
We
That
for
The
your
some
$3,000.00.
of
ADMINISTRATION
Accounts
(Burial
Your
Your
Determine
6
Do
We
Not
resources
money
will
or
be
$26,520.00
Limit
listed
your
used
3,000.00)
$3,391.00
Eligibility
Resource
the
(
Count
Subsidy
vehicles
Count)
$0.00
above.
personal
for
We
do
not
count
the
value
of
possessions.
burial
expenses,
we
also
do
not
count
6
| File Type | application/pdf |
| File Modified | 2021-01-21 |
| File Created | 2021-01-21 |