Extra Help is a federal program that pays some or all of your Medicare Part D premium, lowers your deductible to zero, and caps what you pay for prescriptions at a few dollars per fill. For 2026, a single person can qualify with income up to about $23,940 a year and limited savings, though exact thresholds are updated annually — more on that below. If you’re on a tight budget and paying full price for Medicare drug coverage, this program is worth checking even if you were turned down years ago, because the rules changed in 2024 and made it easier to qualify.
What Extra Help Actually Pays For
Extra Help, officially the Part D Low-Income Subsidy (LIS), works alongside your existing Medicare Part D plan or Medicare Advantage plan with drug coverage. It doesn’t replace your plan — it changes what you pay within it.
Depending on your income, Extra Help can cover:
- Your monthly Part D premium, up to a regional benchmark amount. If your plan charges more than the benchmark, you pay just the difference.
- Your annual deductible, which drops to $0.
- Your copays at the pharmacy, capped at a small fixed amount instead of a percentage of the drug’s cost.
- The coverage gap and catastrophic phases, which effectively disappear — you keep paying the same low copay all year instead of costs rising as you go.
Since 2024, thanks to a change from the Inflation Reduction Act, there’s no more “partial” Extra Help tier with a sliding-scale premium and deductible. If you qualify at all, you get the full subsidy. That’s a meaningful simplification from the old system, which had multiple benefit levels depending on exactly where your income fell, according to CMS.gov.
For 2026, full Extra Help recipients pay no more than $5.10 for generic drugs and $12.65 for brand-name drugs per prescription; copays are lower ($1.60 generic / $4.90 brand) for recipients with income at or below 100% of the federal poverty level, and $0 for the rest of the year once out-of-pocket drug spending reaches the $2,100 annual cap. CMS updates these copay caps every year, so check Medicare.gov’s Extra Help page for the current figures before you budget around them.
Who Qualifies: Income and Resource Limits
Extra Help eligibility depends on two things: your income and your countable resources (savings, investments, and similar assets — not your house or car).
The income limit is tied to the Federal Poverty Level (FPL), which the government updates each January. Because of that annual adjustment, the exact dollar cutoff shifts every year. For 2026, the limits are about $23,940 a year in income for an individual and about $32,460 for a married couple living together — 150% of the 2026 federal poverty guidelines. Somewhat higher amounts can still qualify because of the $20-a-month income disregard, and the limits are higher in Alaska and Hawaii or if you have dependents living with you.
Resource limits also adjust annually. For 2026, an individual can have up to $18,090 in countable resources and a couple up to $36,100; those figures already include an exclusion of $1,500 per person set aside for burial expenses (the base limits are $16,590 and $33,100 before that exclusion). Your home, one car, and personal belongings don’t count toward the limit either.
| Individual (approx.) | Married Couple (approx.) | |
|---|---|---|
| Annual income limit | ~$23,940 (2026) | ~$32,460 (2026) |
| Countable resource limit | $18,090 (2026) | $36,100 (2026) |
| Deductible under Extra Help | $0 | $0 |
| Typical generic copay (2026) | $5.10 | $5.10 |
| Typical brand-name copay (2026) | $12.65 | $12.65 |
These numbers move every year. Before you rule yourself out — or assume you qualify — verify the current-year figures at ssa.gov/extrahelp or medicare.gov, since even being a few hundred dollars over an old limit shouldn’t stop you from applying.
Automatic Enrollment: Do You Even Need to Apply?
If you already have Medicaid, Supplemental Security Income (SSI), or a Medicare Savings Program (MSP) through your state, you’re automatically enrolled in Extra Help — no application needed. Social Security and your state Medicaid office share this information, and you should get a notice (often on purple paper) confirming your automatic enrollment.
Medicare Savings Programs are state-run programs that help pay Medicare Part B premiums and sometimes other cost-sharing. The three main types — Qualified Medicare Beneficiary (QMB), Specified Low-Income Medicare Beneficiary (SLMB), and Qualifying Individual (QI) — each have their own income rules set by your state, and qualifying for any of them triggers automatic Extra Help eligibility. If you’re not sure whether you have one of these, check with your state Medicaid agency, since program names and exact rules vary by state.
If you don’t have Medicaid, SSI, or an MSP, you’ll need to apply for Extra Help directly.
How to Apply If You’re Not Automatically Enrolled
You can apply for Extra Help in any of these ways:
- Online at ssa.gov through the Extra Help application (Social Security’s Form SSA-1020).
- By phone, calling Social Security at 1-800-772-1213 (TTY 1-800-325-0778) to request an application or complete it over the phone.
- In person at your local Social Security office.
- Through your state Medicaid office, which can also process Extra Help applications in many states.
The application asks about your income, resources, and household size. You’ll typically need recent pay stubs, Social Security benefit statements, pension statements, and bank or investment account statements. There’s no fee to apply, and you can apply at any time during the year — there’s no single open enrollment deadline for Extra Help itself, unlike Part D plan changes.
Social Security reviews your application and mails you a decision letter. If approved, Extra Help is generally effective as of the month you applied (not the month after approval), and Social Security applies it retroactively in some cases — including automatic awards for people who qualify through Medicaid, SSI, or a Medicare Savings Program. Your approval notice states your exact effective date; confirm it against SSA.gov if it looks wrong.
What Happens After You Apply
If approved, Social Security notifies your Part D plan directly, so you don’t need to separately contact your insurer about the subsidy itself. Your next Explanation of Benefits should reflect the lower deductible and copays.
If your current plan isn’t a good fit, Extra Help gives you a special enrollment period to switch Part D or Medicare Advantage plans outside the normal Fall Open Enrollment window (October 15–December 7). This matters because the subsidy only fully covers premiums up to a regional benchmark — if your plan is priced above that benchmark, switching to a benchmark plan means you pay nothing for the premium at all.
If denied, the letter will explain why — usually income or resources over the limit — and you have the right to appeal within 60 days. Circumstances change: a spouse’s income drops, medical bills reduce countable resources, or you re-apply the following year when the limits rise. It’s worth trying again if your situation shifts.
Re-verification happens periodically. Each year Social Security selects a sample of Extra Help recipients for review, mailing redetermination notices beginning at the end of August; if you aren’t selected, your Extra Help continues unchanged. Respond promptly — missing the deadline can cause your Extra Help to lapse even if you’d still qualify.
Extra Help and Other Programs Working Together
Extra Help doesn’t exist in isolation. Many people who qualify for it also qualify for a Medicare Savings Program, which covers the Part B premium (a separate cost from Part D). Applying for one often surfaces the other, since state Medicaid offices frequently screen for both at once. If you’re managing Medicare on a limited income, it’s worth asking your state Medicaid office or State Health Insurance Assistance Program (SHIP) counselor to check your eligibility for both in the same conversation — SHIP counseling is free and funded by federal grants from the U.S. Administration for Community Living, and you can find your local office through medicare.gov.
FAQ
How much can Extra Help save me each year?
It depends on your drugs and your current plan, but for someone taking several brand-name medications, the savings from a $0 deductible, no coverage gap, and capped copays can run into the thousands of dollars annually. The exact amount varies by prescription list and plan, so compare your last year’s Part D costs against the Extra Help copay caps published at medicare.gov to estimate your own savings.
Can I still qualify if I have a small retirement account or life insurance policy?
It depends on the type of asset. Retirement accounts like 401(k)s and IRAs generally do count as resources for Extra Help, while your home, one vehicle, and term life insurance typically don’t. Whole life insurance’s cash value can count. Because the rules are specific, review SSA’s guidance on countable resources or speak with a Social Security representative before assuming you’re over the limit.
Does applying for Extra Help affect my other benefits, like Social Security retirement or SSI?
No. Applying for Extra Help doesn’t reduce your Social Security retirement, disability, or SSI benefits, and it isn’t counted as income for other federal programs. It’s a standalone subsidy for Medicare Part D costs, administered by Social Security but paid through your Medicare drug plan.
Sources
- https://www.ssa.gov/medicare/part-d-extra-help
- https://www.medicare.gov/basics/costs/help/drug-costs
- https://www.cms.gov
- https://www.ssa.gov/benefits/medicare
Related reading
- Social Security COLA for 2026: How Much Bigger Will Your Check Be?
- Medicare Open Enrollment: Dates, What You Can Change, and Costly Mistakes
- Medicare Advantage vs Original Medicare: A Plain-English Comparison