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Your Next Steps After A Medicare Loss of Deemed Status Notice

Last updated June 17th, 2020

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Depending on your income and assets, you may qualify for Medicare’s Extra Help program. Once you’re enrolled in the program, Extra Help helps pay for some-to-most of the costs for Medicare prescription drug coverage (Medicare Part D).

However, if your income and resources have changed within the last year, you may no longer automatically qualify to receive Extra Help. If this is the case, you’ll receive a Loss of Deemed Status Notice — also known as Form 11198, or a grey notice — in the mail.

This grey notice informs you that, beginning on January 1, your automatic enrollment in Extra Help will end. This means that the costs for your Medicare Part D drug coverage may increase.

How Do You Automatically Qualify For Extra Help? And Why Is Your Extra Help Ending?

You automatically qualify for Extra Help if one of the following applies to you:

  • You have both Medicare and Medicaid
  • You belong to a Medicare Savings Program (MSP)
  • You receive Supplemental Security Income (SSI)

If you no longer belong to any of those programs, you may not automatically qualify for Extra Help any more. In this article, we’ll discuss how you can requalify for Extra Help.

Does This Affect The Rest Of Your Medicare Coverage?

Extra Help specifically helps you with Medicare Part D. Your enrollment in the Extra Help program does not affect your enrollment in Medicare Part A or B. So if you receive a Loss of Deemed Status Notice and/or are no longer are eligible for Extra Help, the only part of your coverage that may be affected is your prescription drug coverage (Medicare Part D).

When Would You Receive This Notice?

This notice is mailed out in September, but you’ll continue getting Extra Help under your current plan through December 31.

If you do receive this notice, you should take steps immediately to either apply for Extra Help on your own or find a new Medicare prescription drug plan that best suits your healthcare needs.

What Do You Need To Do If You Receive A Loss of Deemed Status Notice?

Just because your automatic enrollment is ending, it does not mean you can’t get Extra Help. If you’re no longer eligible because your financial situation has put you above eligibility limits, it’s possible you may still qualify. Some examples of factors that may mean you can still get Extra Help are:

  • Certain types of income you have may not be counted
  • You support other family members who live with you
  • You live in Alaska or Hawaii, where income thresholds are higher

If you suspect that your situation is one where you still qualify to receive Extra Help, you’ll need to apply to find out. You can apply in a few different ways.

  • If you received the Loss of Deemed Status Notice in the mail, it should have included an application for Extra Help. Complete the application and mail it back in the postage-paid envelope.
  • Apply online by visiting https://secure.ssa.gov/i1020/start
  • Call Social Security at (800) 772-1213.

You should apply for Extra Help as soon as possible to make sure that you qualify for the upcoming year. If you don’t qualify, you should take the time to compare new plans so you can enroll in the one that’s right for you before December 31.

What Should You Do If You Don’t Qualify For Extra Help (Even After Applying)?

If you don’t qualify for Extra Help, there are still options to help lower your prescription drug costs.

  • You may want to switch to a new Medicare drug plan. Take the time to compare plans in your area, including your current plan. Be sure to check to see if the plan covers the prescriptions you regularly take as well as whether or not you can keep using your same pharmacy if that’s important to you. You can visit HealthCare.com to ask a licensed, independent agent to help find a plan that is right for you.
  • Your state may have programs that can help pay your prescription drug costs. You can contact your local Medicaid or social services office for more information.
  • If your income and resources change and you believe you qualify for Extra Help again, you can re-apply at any time throughout the year.
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