If the Social Security Administration (SSA) denies your Extra Help application and you disagree, you have two opportunities to request that your case be reexamined.

1. Before the final decision

  • If your application is going to be denied, you will receive a Pre-Decisional Notice before being formally denied. The Pre-Decisional Notice explains that you may not be eligible for Extra Help and why you will be denied (for example, the monthly income you reported in your application is over the limit). If you think that SSA’s rejection is based on incorrect information, you can correct your application.
  • You have 10 days from the date on the notice to make corrections. It may be fastest to call or visit your local SSA field office using the telephone number or address on the notice. You can also call SSA’s national hotline at 800-772-1213.

2. After the final decision

Once SSA makes a final decision, you will receive either a Notice of Award explaining what level of Extra Help you qualify for (full or partial) or a Notice of Denial, meaning you do not qualify. If you disagree with SSA’s decision, either because you were given partial instead of full Extra Help or because you were denied, you can appeal. In both cases, it is better to appeal than to reapply. This is because if your appeal is successful, your Extra Help will be effective from the first day of the month that you originally submitted an application.

Appeal process

  1. Request a hearing within 60 days of receiving notice of SSA’s decision. Note: If you have a good reason for missing your appeal deadline, you may be eligible for a good cause extension.
    • If you do not want a hearing, you can request a case review where an SSA agent will review your application and any additional information you send in.
  2. Set a date for a hearing by calling your local SSA office or the national hotline at 800-772-1213. You can also download an online form and mail it to request a hearing. Generally, SSA will suggest a date at least 20 days after your request, giving you time to prepare. However, you can waive the 20-day preparation period if you want your hearing to be held sooner.
  3. Participate in your hearing. Hearings are held by phone. You will get a notice in the mail that confirms the date of your hearing and gives you a toll-free number to call. This notice also explains how to submit evidence supporting your case (for example, bank statements that show your assets). If you have a scheduling conflict, you can reschedule your hearing if you have good cause.
  4. After your hearing or review, SSA will send you a notice with the final decision on your case. If you still disagree with the decision, you can file an appeal in Federal District Court.

Return to: Medicare Admin

This content was created and copyrighted by the Medicare Rights Center ©2021. Medicare Rights Center is a national, nonprofit consumer service organization that works to ensure access to affordable health care for older adults and people with disabilities. These materials are presented here with support from YourMedicare.com and may not be distributed, modified or edited without Medicare Rights’ consent.

YourMedicare.com takes pride in providing you as much information as possible concerning your Medicare options, but only a health insurance broker licensed to sell Medicare can help you compare your plan options from various insurance companies. When you’re ready, we recommend you discuss your needs with a YourMedicare.com Licensed Sales Agent.