Prescription drugs are one of the biggest costs people face on Medicare. Extra Help is a federal program that lowers what you pay for Medicare Part D drug coverage, including premiums, deductibles and copays. It is also called the Part D Low-Income Subsidy (LIS). Many people who qualify for Extra Help don’t know it exists, and others assume the income limits are much lower than they really are.
This guide explains how Extra Help works in 2026, who qualifies, how much it can save you and how to apply.
Quick answer: In 2026, you may qualify for Extra Help if your yearly income is below about $23,940 as an individual or $32,460 as a married couple, and your resources are below $18,090 or $36,100. With Extra Help, you pay no Part D deductible, no premium for many drug plans, and no more than $5.10 for generic drugs and $12.65 for brand-name drugs. (SSA.gov)
What Is Medicare Extra Help?
Extra Help is run by Medicare and Social Security. It works with any Medicare drug coverage, whether you have a stand-alone Part D plan with Original Medicare or a Medicare Advantage plan that includes drug coverage.
When you qualify for Extra Help, it can pay for:
- Your monthly Part D premium, fully or in part
- Your yearly Part D deductible
- Most of the cost of each prescription, leaving you with small copays
- Any Part D late enrollment penalty you would otherwise owe
Since 2024, everyone who qualifies receives the full benefit. There used to be a partial level of the subsidy for people with slightly higher incomes, but that was expanded by the Inflation Reduction Act, so more people now get the most generous level.
Extra Help Income and Resource Limits for 2026
To qualify for Extra Help, both your income and your resources must be under the limits. Here are the 2026 figures:
| Individual | Married couple | |
|---|---|---|
| Yearly income limit | $23,940 | $32,460 |
| Approximate monthly income | about $1,995 | about $2,705 |
| Resource limit | $18,090 | $36,100 |
These limits are based on 150% of the federal poverty level. They are a little higher in Alaska and Hawaii. The resource limits already include up to $1,500 per person that you say you plan to use for burial expenses. (Mass Legal Services)
What counts as income
Social Security looks at most kinds of income, including Social Security benefits, pensions, wages and interest. Some income doesn’t count, such as food stamps (SNAP), housing assistance, home energy assistance and some disaster relief. If you are still working, part of your earnings is also excluded. If you support relatives who live with you, the income limits may be higher.
What counts as resources
Resources include bank accounts, stocks, bonds, mutual funds, IRAs and cash at home. These are not counted:
- Your home and the land it sits on
- Your car or cars
- Personal belongings and household goods
- Life insurance policies
- Burial plots and irrevocable burial contracts
- Back payments from Social Security or SSI, for a limited time
What You Pay With Extra Help in 2026
Here is how drug costs compare with and without the subsidy in 2026:
| Part D cost | Standard 2026 Part D | With Extra Help |
|---|---|---|
| Monthly premium | Varies by plan | $0 for benchmark plans; reduced for others |
| Yearly deductible | Up to $615 | $0 |
| Generic drugs | Up to 25% coinsurance | No more than $5.10 |
| Brand-name drugs | Up to 25% coinsurance | No more than $12.65 |
| Yearly out-of-pocket cap | $2,100 | $0 after the cap |
| Late enrollment penalty | Applies if you delayed coverage | Waived |
For many people, Extra Help is worth thousands of dollars a year. For someone taking several brand-name drugs, the savings can be even higher.
Benchmark plans
Every year, Medicare sets a “benchmark” premium amount in each region. If you have the subsidy and choose a Part D plan with a premium at or below the benchmark, you pay $0 for the premium. If you choose a more expensive plan, you pay the difference. This is why plan choice still matters even when your costs are low.
Who Automatically Gets Extra Help?
You don’t need to apply for Extra Help if you already have one of the following. Medicare will enroll you automatically:
- Full Medicaid coverage
- A Medicare Savings Program (QMB, SLMB or QI)
- Supplemental Security Income (SSI) benefits
If you qualify automatically, Medicare sends a purple letter confirming your status. If you aren’t in a drug plan, Medicare may also enroll you in one so that you have coverage. You can switch to a different plan if it doesn’t cover your drugs well.
Because Medicare Savings Programs have their own income limits, applying for one can be a smart way to get the subsidy too. Learn more in our guide to Medicare Savings Programs.
How to Apply for Extra Help
If you don’t qualify automatically, you can apply through Social Security at any time of year. There is no enrollment window. The application is free and usually takes about 30 minutes.
- Apply online at ssa.gov/extrahelp, which is the fastest option.
- Call Social Security at 1-800-772-1213 (TTY 1-800-325-0778) and apply by phone.
- Visit a local Social Security office and apply in person.
Social Security will ask about your income, savings, investments and life insurance. You don’t usually need to send documents with the application, but have your bank statements, pension information and tax return handy so your answers are accurate. Social Security may check your information with other agencies.
What happens after you apply
Social Security reviews your application and sends you a letter with its decision, usually within a few weeks. If you are approved:
- Your benefit usually starts the first day of the month you applied.
- Your drug plan is notified and should lower your premium and copays.
- If you paid more than you should have, your plan should refund the difference.
- You can use a Special Enrollment Period to change drug plans if you want a better fit.
If you are denied and think the decision is wrong, you can ask for an appeal. Call Social Security or follow the instructions in your decision letter.
Extra Help and the Monthly Special Enrollment Period
One of the most useful parts of Extra Help is flexibility. People in the program can use a monthly Special Enrollment Period to:
- Switch from one stand-alone Part D plan to another
- Leave a Medicare Advantage plan with drug coverage and return to Original Medicare with a stand-alone Part D plan
Changes take effect the first day of the following month. This SEP can’t be used to join a different Medicare Advantage plan. For that, you would generally use the Open Enrollment Period from October 15 to December 7 or another qualifying SEP. Read our full guide to the Medicare Special Enrollment Period to see all your options.
Extra Help With Medicare Advantage and Special Needs Plans
If you prefer Medicare Advantage, Extra Help still works for you. The subsidy applies to the drug portion of your plan. In many areas, there are $0 premium Medicare Advantage plans with drug coverage, and with the subsidy your copays for covered drugs drop to the low Extra Help amounts.
If you also have Medicaid, you may qualify for a Dual Eligible Special Needs Plan (D-SNP). These plans are designed for people with both Medicare and Medicaid and often include extra benefits such as dental, vision, hearing, transportation and over-the-counter allowances. Our guide to dual eligibility for Medicare and Medicaid explains how these plans work.
Keep in mind that the monthly Special Enrollment Period for people with Extra Help can’t be used to join a new Medicare Advantage plan. People with full Medicaid may have a separate monthly option to join certain integrated D-SNPs, depending on their state.
How to Choose a Drug Plan With Extra Help
Extra Help lowers your costs, but the plan you pick still makes a difference. When comparing plans, check:
- Your drugs are on the formulary. A plan that doesn’t cover one of your medications can cost you more, even with help.
- The premium is at or below the benchmark. That way, your premium is $0.
- Your pharmacy is in network. Preferred pharmacies may also have lower copays.
- Coverage rules. Look for prior authorization, step therapy or quantity limits on your drugs.
The Medicare Plan Finder lets you enter your drugs and see your estimated costs with your subsidy. You can also ask us to compare plans for you. Our guide to Medicare Part D covers more tips on choosing drug coverage.
Extra Help: Two Real-World Examples
Example 1: Brand-name diabetes and heart medications
George, 74, takes two brand-name drugs and two generics each month. His income is $1,800 a month from Social Security and a small pension, and he has about $9,000 in savings. Without the subsidy, he would pay the $615 deductible and then 25% coinsurance until he reached the $2,100 yearly cap.
George applies online and is approved. Now he pays no deductible, a $0 premium on a benchmark plan, $12.65 for each brand-name prescription and $5.10 for each generic. His yearly drug costs drop from as much as $2,100 to about $430.
Example 2: Already on a Medicare Savings Program
Evelyn lives in New York and was recently approved for QMB. A few weeks later, she receives a purple letter from Medicare saying she automatically qualifies for Extra Help. She uses the monthly Special Enrollment Period to move to a drug plan that covers all of her medications at a lower cost.
What to Do if Your Pharmacy Doesn’t Show Your Extra Help
Sometimes there is a delay between your approval and your drug plan’s records. If the pharmacy charges you full price after you have been approved, you have options:
- Show proof of your status. Your purple letter from Medicare, your Social Security award letter, or a Medicaid card can serve as proof. Medicare calls this “Best Available Evidence,” and plans must accept it.
- Call your drug plan. Ask member services to update your low-income subsidy level.
- Ask about temporary coverage. If you have Medicaid or SSI and no drug plan yet, Medicare’s Limited Income Newly Eligible Transition (LI NET) program can provide temporary drug coverage until you are enrolled in a plan.
- Keep your receipts. If you overpaid, your plan should reimburse you once your status is updated.
Extra Help vs the Medicare Prescription Payment Plan
Since 2025, Medicare has offered another option called the Medicare Prescription Payment Plan. It lets you spread your out-of-pocket drug costs into monthly payments across the year instead of paying everything at the pharmacy counter. It is open to anyone with Part D, regardless of income.
Here is how the two programs differ:
| Extra Help | Medicare Prescription Payment Plan | |
|---|---|---|
| Lowers what you pay? | Yes, it reduces premiums, deductibles and copays | No, it only spreads payments over time |
| Income limits? | Yes | No |
| Who to contact | Social Security | Your Part D plan |
| Best for | People with limited income and resources | People with high drug costs early in the year |
If you qualify for Extra Help, it is almost always the better choice, because your costs are already low. The payment plan is more helpful for people who don’t qualify but have expensive prescriptions.
Helping a Parent Apply for Extra Help
Many adult children help a parent apply for the program. You can make the process easier by planning ahead:
- Gather the numbers first. Write down your parent’s monthly income from every source and the current balance of each bank and investment account.
- Apply together. You can help with the online application, but your parent should be present to answer questions and give permission.
- Set up permission to speak for them. Ask Social Security and the drug plan what forms are needed for you to discuss your parent’s account.
- Check the drug list. After approval, make sure your parent’s plan covers all of their medications at the lowest cost.
- Calendar the reviews. Note when redetermination letters usually arrive so nothing is missed.
If your parent also struggles with the Part B premium, check whether they qualify for a Medicare Savings Program at the same time. Approval for an MSP brings Extra Help automatically.
Common Mistakes With Extra Help
- Assuming you don’t qualify. The income limits are higher than many people think, and your home and car don’t count.
- Not reporting changes. If your income, resources or marital status change, Social Security may review your eligibility. Report changes promptly.
- Ignoring redetermination letters. Social Security periodically reviews eligibility. If you get a review form, return it on time so you don’t lose your benefit.
- Staying in an expensive plan. If your plan’s premium is above the benchmark, you may be paying more than you need to.
- Forgetting to check every fall. Benchmark plans change each year. A plan that was $0 this year might not be next year.
Extra Help Changes for 2027
Standard Part D costs are rising in 2027. The maximum deductible goes up to $700, and the yearly out-of-pocket cap goes up to $2,400. People in the program are largely protected from these increases, because their deductible stays at $0 and their copays stay low. The 2027 Extra Help income and resource limits will be updated when the new federal poverty guidelines are released.
Still, it is wise to review your drug plan during Open Enrollment, since benchmark plans in your region may change. Our guide to Medicare Open Enrollment 2027 mistakes explains what to look for.
Frequently Asked Questions About Extra Help
Is Extra Help the same as Medicaid?
No. Extra Help only lowers your Part D drug costs. Medicaid is broader health coverage. But if you have Medicaid, you automatically get it.
Can I get Extra Help if I own a home?
Yes. Your home isn’t counted as a resource, no matter what it is worth.
Do I have to reapply for Extra Help every year?
Usually not. Social Security may review your eligibility from time to time. If you qualify automatically through Medicaid, an MSP or SSI, your status is checked each year based on those programs.
Does Extra Help work with Medicare Advantage?
Yes. If your Medicare Advantage plan includes drug coverage, the subsidy lowers your drug costs and can reduce the part of your plan premium that covers Part D.
Can I apply for Extra Help at any time?
Yes. There is no deadline. You can apply any time of the year through Social Security.
Does Extra Help pay my Part B premium?
No. Extra Help only covers Part D drug costs. If you need help with your Part B premium, look into Medicare Savings Programs, which pay the Part B premium and automatically include Extra Help.
Related guides: the Medicare late enrollment penalty.
Get Help Lowering Your Drug Costs
If prescription costs are hard to manage, Extra Help could make a big difference. Caring Curations is an independent Medicare agency in Staten Island, New York. We help people understand programs like Extra Help and compare Part D and Medicare Advantage plans based on their actual prescriptions.
Book a free Medicare consultation or call 848-257-9344. We are licensed in 25 states, contracted with 15 insurance carriers, and our help is always free.
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