Prescription drugs are expensive. Even with Medicare Part D, the copays and deductibles can add up fast. Some people spend hundreds of dollars a month on medications they need to survive.
But there’s a program that can cut your prescription costs to almost nothing. It’s called Medicare Extra Help. And millions of people who qualify don’t even know it exists.
This guide explains what Extra Help is, who qualifies, and how to apply. It could save you $5,000 or more per year on your medications.
What Is Medicare Extra Help?
Medicare Extra Help (also called the Low Income Subsidy or LIS) is a federal program that helps people with limited income and resources pay for their Medicare Part D prescription drug costs.
What Extra Help pays for:
- Part D monthly premiums — reduced or $0
- Part D annual deductible — reduced or $0
- Prescription copays — reduced to $0 to $11 per prescription
Without Extra Help, a typical Part D plan costs:
- Premium: $7 to $100/month
- Deductible: up to $590/year
- Copays: $10 to $100+ per prescription depending on the drug tier
With Extra Help, your costs drop dramatically:
- Premium: $0 for many plans
- Deductible: $0
- Copays: $1.55 to $4.50 for generics, $3.95 to $11.20 for brand-name drugs (2026 amounts)
The savings are enormous. A person spending $300/month on prescriptions could see their costs drop to $20-$40/month. Over a year, that’s $3,000 to $5,000+ in savings.
Who Qualifies for Medicare Extra Help?
You may qualify if you meet both of these requirements:
Income Limits (2026)
- Single: Income below approximately $22,590 per year ($1,882/month)
- Married (living together): Combined income below approximately $30,660 per year ($2,555/month)
What counts as income:
- Social Security benefits
- Pension payments
- Wages (if you’re still working)
- Interest and dividends
- Rental income
What does NOT count as income:
- Money from family or friends
- Housing assistance
- Home energy assistance
- Food assistance (SNAP)
- One-time payments (tax refunds, insurance settlements)
Resource Limits (2026)
- Single: Resources below approximately $17,220
- Married (living together): Combined resources below approximately $34,360
What counts as resources:
- Money in checking and savings accounts
- Stocks, bonds, and mutual funds
- Cash value of life insurance policies
- Real estate (other than your primary home)
What does NOT count as resources:
- Your home (primary residence)
- Your car
- Personal belongings
- Household items
- Burial plots
- Up to $1,500 set aside for burial expenses ($3,000 for a couple)
- Life insurance policies with a face value of $1,500 or less
These limits are higher than most people think. Many seniors assume they make too much to qualify. But the income and resource limits are generous enough that about 1 in 4 people on Medicare may qualify. It’s always worth checking.
How Much Can You Save?
Here are real examples of what Extra Help looks like:
Example 1: Full Extra Help
Maria, single, income $15,000/year, $5,000 in savings
Without Extra Help:
- Part D premium: $39/month = $468/year
- Deductible: $590/year
- Copays for 5 medications: $180/month = $2,160/year
- Total annual drug costs: $3,218
With Full Extra Help:
- Part D premium: $0
- Deductible: $0
- Copays: $1.55 per generic, $3.95 per brand = approximately $15/month = $180/year
- Total annual drug costs: $180
Annual savings: $3,038
Example 2: Partial Extra Help
Robert, single, income $20,000/year, $12,000 in savings
Without Extra Help:
- Part D premium: $45/month = $540/year
- Deductible: $590/year
- Copays for 4 medications: $120/month = $1,440/year
- Total annual drug costs: $2,570
With Partial Extra Help:
- Part D premium: reduced to $15/month = $180/year
- Deductible: $119
- Copays: approximately $4.50 to $11.20 per prescription = $40/month = $480/year
- Total annual drug costs: $779
Annual savings: $1,791
Example 3: Full Extra Help + Medicare Savings Program
Dorothy, single, income $12,000/year, $3,000 in savings
Dorothy qualifies for both Extra Help AND a Medicare Savings Program. Her Part B premium ($202.90/month) is paid by the state. Her prescriptions cost almost nothing.
Her total annual Medicare costs: under $200. Without these programs, she’d be paying $5,000+ per year.
Full Extra Help vs Partial Extra Help
There are two levels of Extra Help:
Full Extra Help
You get this if:
- Your income is below $19,683/year (single) or $26,622/year (married)
- Your resources are below $10,780 (single) or $21,500 (married)
- OR you already receive Medicaid, SSI, or are in a Medicare Savings Program
Full Extra Help benefits:
- $0 Part D premium (for plans at or below the benchmark amount)
- $0 deductible
- $1.55 copay for generics, $3.95 for brand-name drugs (below 100% poverty)
- OR $4.50 copay for generics, $11.20 for brand-name drugs (100-135% poverty)
Partial Extra Help
You get this if:
- Your income is between the Full Extra Help limit and $22,590/year (single) or $30,660/year (married)
- Your resources are below $17,220 (single) or $34,360 (married)
Partial Extra Help benefits:
- Reduced Part D premium (you pay a sliding-scale amount)
- $119 deductible (instead of up to $590)
- 15% coinsurance (instead of 25%)
- Still saves you hundreds to thousands per year
How to Apply for Medicare Extra Help
Applying is free and takes about 15-20 minutes. There are three ways to apply:
Option 1: Online (Fastest)
Go to ssa.gov/extrahelp and complete the application online. You’ll need:
- Your Social Security number
- Your date of birth
- Your address
- Information about your income (Social Security amount, pension, wages)
- Information about your resources (bank accounts, investments)
- Information about your current Part D plan
You’ll get a decision within a few weeks by mail.
Option 2: By Phone
Call Social Security at 1-800-772-1213 and apply over the phone.
- Hours: Monday through Friday, 8am to 7pm
- TTY: 1-800-325-0778
- Have your income and resource information ready
Option 3: In Person
Visit your local Social Security office. Bring:
- Photo ID
- Social Security card or Medicare card
- Bank statements (checking and savings)
- Investment account statements
- Pension or income documentation
- Information about your Part D plan
Find your nearest office at ssa.gov/locator.
Option 4: Through Your State
You can also apply through your State Health Insurance Assistance Program (SHIP). SHIP counselors help you fill out the application for free.
- Call SHIP at 1-877-839-2675
- Find your local SHIP at shiphelp.org
SHIP counselors are especially helpful because they can also check if you qualify for Medicare Savings Programs and other state assistance at the same time.
Automatic Qualification
Some people are automatically enrolled in Extra Help without applying:
You automatically get Full Extra Help if you:
- Receive Medicaid (full benefits)
- Receive Supplemental Security Income (SSI)
- Are in a Medicare Savings Program (QMB, SLMB, or QI)
If you’re automatically enrolled, you’ll receive a letter from Medicare telling you. You don’t need to do anything except choose a Part D plan (or one will be assigned to you).
If you receive Medicaid or SSI and did NOT receive an Extra Help notice, call 1-800-MEDICARE to make sure you’re enrolled.
Extra Help and Your Part D Plan
Choosing a Plan With Extra Help
When you have Extra Help, you should choose a Part D plan that is at or below the benchmark premium amount in your area. If you choose a benchmark plan, your monthly premium is $0.
How to find benchmark plans:
- Go to Medicare.gov → Plan Finder
- Enter your zip code and medications
- Look for plans marked as “$0 premium with Extra Help”
If you choose a plan ABOVE the benchmark, you’ll pay the difference between the benchmark and your plan’s premium. This could be $10 to $50/month. Always try to choose a benchmark plan to maximize your savings.
Changing Plans
People with Extra Help get a Special Enrollment Period that allows them to switch Part D plans once per quarter during the first three quarters of the year (January-March, April-June, July-September). This is more flexibility than most Medicare beneficiaries have.
Use this flexibility. If your plan changes its formulary and your drugs cost more, switch to a better plan. You’re not locked in like other Part D enrollees.
What If You’re Denied?
If your application is denied, you have options:
Check the Reason
Social Security will send you a letter explaining why. Common reasons:
- Income slightly above the limit
- Resources slightly above the limit
- Missing information on the application
Appeal
You have 60 days to appeal the decision. The appeal process is:
- Request a reconsideration from Social Security
- Provide additional documentation if needed
- A different person reviews your case
Appeals are often successful when people provide more detailed information about their expenses and resources.
Reapply Later
Your income and resources can change. If you’re denied today, you can reapply at any time. Common reasons to reapply:
- Your income decreased (you stopped working, pension reduced)
- Your resources decreased (medical bills, home repairs)
- The income/resource limits increased (they adjust annually)
- Your spouse passed away (your household size changed)
Look Into Medicare Savings Programs
Even if you don’t qualify for Extra Help, you might qualify for a Medicare Savings Program through your state. These programs pay your Part B premium ($202.90/month) and sometimes more. Contact your state Medicaid office to check.
Medicare Extra Help + Medicare Savings Programs
These two programs work together to provide maximum savings:
Extra Help = saves you money on prescriptions (Part D)
Medicare Savings Programs = saves you money on premiums, deductibles, and coinsurance (Part A and Part B)
If you qualify for one, you may qualify for both. And qualifying for a Medicare Savings Program automatically qualifies you for Full Extra Help.
Medicare Savings Programs include:
QMB (Qualified Medicare Beneficiary):
- Pays your Part B premium ($202.90/month)
- Pays your Part A premium (if you have one)
- Pays your deductibles and coinsurance
- Income limit: approximately $1,255/month (single)
SLMB (Specified Low-Income Medicare Beneficiary):
- Pays your Part B premium ($202.90/month)
- Income limit: approximately $1,504/month (single)
QI (Qualifying Individual):
- Pays your Part B premium ($202.90/month)
- Income limit: approximately $1,692/month (single)
Apply for Medicare Savings Programs through your state Medicaid office. SHIP counselors can help you apply for both programs at the same time.
Common Myths About Extra Help
Myth 1: “I make too much to qualify”
The income limits are higher than most people think. A single person earning up to $22,590/year may qualify. That’s about $1,882/month. Many seniors on Social Security fall within this range. It costs nothing to apply and find out.
Myth 2: “I own my home so I won’t qualify”
Your home doesn’t count as a resource. Neither does your car, your personal belongings, or your household items. Only liquid assets like bank accounts and investments count.
Myth 3: “It’s too complicated to apply”
The application takes 15-20 minutes online at ssa.gov/extrahelp. Or call 1-800-772-1213 and someone walks you through it. SHIP counselors will do it with you for free.
Myth 4: “If I get Extra Help, I’ll lose other benefits”
Extra Help does not affect your Social Security benefits, your Medicare coverage, or your housing assistance. It’s additional help on top of what you already receive.
Myth 5: “I already have Part D so I don’t need it”
Extra Help works WITH your Part D plan. It reduces what you pay within that plan. You keep your Part D coverage — Extra Help just makes it much cheaper.
Frequently Asked Questions
How do I know if I qualify for Medicare Extra Help? The fastest way is to apply online at ssa.gov/extrahelp. You can also use the online screening tool at benefitscheckup.org or call SHIP at 1-877-839-2675 for a free benefits check.
Does Extra Help cost anything to apply? No. The application is completely free. There is no fee, no enrollment charge, and no catch.
How long does it take to get approved? Typically 2-4 weeks after submitting your application. You’ll receive a decision letter by mail.
Can I have Extra Help and a Medicare Advantage plan? Yes. If your Medicare Advantage plan includes Part D drug coverage, Extra Help applies to the drug coverage portion.
What happens if my income changes? If your income increases above the limit, you may lose Extra Help. If it decreases, you may qualify for more help. Social Security reviews your eligibility periodically. You can reapply at any time if your circumstances change.
Does my spouse’s income count? If you’re married and living together, your combined income and resources are counted. If you’re separated, only your individual income and resources count.
Can I apply for Extra Help and Medicare Savings Programs at the same time? Yes. SHIP counselors can help you apply for both simultaneously. Qualifying for a Medicare Savings Program automatically qualifies you for Full Extra Help.
What if I don’t have Part D yet? You should sign up for Part D and apply for Extra Help at the same time. People with Extra Help get a Special Enrollment Period to join Part D outside the normal enrollment window — and they don’t pay a late enrollment penalty.
How much does Medicare cost with Extra Help? With Full Extra Help, your Part D costs drop to near-$0. Combined with a Medicare Savings Program, your total Medicare costs could be under $200/year. Without these programs, the same coverage could cost $3,000 to $6,000+ per year.
What to Do Right Now
- Check if you qualify. Go to ssa.gov/extrahelp right now and complete the application. It takes 15-20 minutes and it’s free. Even if you think you make too much, apply anyway. You might be surprised.
- If you help a parent or grandparent with their healthcare, check their eligibility. Many seniors don’t know Extra Help exists. You could save them thousands per year.
- Call SHIP at 1-877-839-2675 for free, unbiased help. They’ll check your eligibility for Extra Help AND Medicare Savings Programs at the same time.
- If you already have Extra Help, make sure you’re in a benchmark Part D plan with a $0 premium. Use Medicare.gov Plan Finder to check.
- If you were denied, consider appealing or reapplying if your circumstances have changed. The limits adjust every year and your income or resources may have changed.
Prescription drugs shouldn’t force you to choose between your medications and your groceries. Medicare Extra Help exists to make sure that doesn’t happen. It’s free to apply. It saves thousands per year. And millions of people who qualify haven’t signed up yet. Don’t be one of them.