Quick Answer
Extra Help (Low Income Subsidy) is a federal program that helps people with limited income and resources pay for Medicare Part D prescription drug costs, including premiums, deductibles, and copays. In 2026, individuals with monthly income up to $2,015 may qualify.
Coverage Comparison by Plan Type
| Plan Type | Coverage | Notes |
|---|---|---|
| Full Extra Help (Level 1) | $0 premium, $0 deductible, minimal copays | Auto-enrolled if you have Medicaid, SSI, or Medicare Savings Program |
| Partial Extra Help (Level 2) | Reduced premium, $0 deductible, low copays | Income between 135%-150% of Federal Poverty Level |
| Medicare Savings Programs (MSP) | Covers Part B premiums; may auto-qualify for Extra Help | QMB, SLMB, QI programs also reduce Medicare costs |
| No Extra Help | Standard Part D costs apply | Income/resources above the LIS limits |
Understanding Your Coverage Options
What Extra Help Covers
Extra Help pays for most or all of your Medicare Part D prescription drug plan costs. This includes the monthly premium, annual deductible, and copayments or coinsurance for covered drugs.
Beneficiaries with full Extra Help pay no more than a small copay per prescription — typically $4.50 for generics and $11.20 for brand-name drugs in 2025.
What It Covers
- Part D monthly premiums (up to the benchmark amount)
- Part D annual deductible ($0 for full Extra Help)
- Copays: $4.50 generics / $11.20 brand-name (2025, full LIS)
- Coverage gap (donut hole) costs
What It Doesn't Cover
- Part A or Part B premiums (covered by Medicare Savings Programs instead)
- Drugs not covered by your Part D plan
- Over-the-counter medications
- Non-drug medical expenses
Automatic Enrollment
If you receive Medicaid, Supplemental Security Income (SSI), or are enrolled in a Medicare Savings Program, you are automatically enrolled in Extra Help. No separate application needed.
Eligibility: Income & Resource Limits
To qualify for Extra Help, your income and resources must fall below certain limits set by the Social Security Administration. These limits are updated annually.
For 2026, individuals with monthly income up to $2,015 (or $2,725 for married couples) may qualify. Resource limits are $17,220 for individuals and $34,360 for couples.
What It Covers
- 2026 income limit: $2,015/month individual ($24,180/year)
- 2026 income limit: $2,725/month married couple ($32,700/year)
- 2026 resource limit: $17,220 individual / $34,360 couple
- Resources exclude: home, car, burial funds, life insurance
What It Doesn't Cover
- Income above 150% of Federal Poverty Level generally disqualifies
- Resources include: bank accounts, stocks, bonds, second homes
- Employer pension income counts toward income limits
How to Apply for Extra Help
You can apply for Extra Help at any time of year through Social Security. There is no open enrollment window — you can apply whenever you become eligible.
Once approved, you will receive a notice from Social Security and be able to enroll in or change your Part D plan during a Special Enrollment Period.
What It Covers
- Online: Apply at ssa.gov/medicare/part-d-extra-help
- Phone: Call Social Security at 1-800-772-1213
- In person: Visit your local Social Security office
- State Medicaid office may also process applications
What It Doesn't Cover
- Applications are not processed through Medicare.gov
- SHIP counselors can help but cannot submit on your behalf
Special Enrollment Period
When you qualify for Extra Help, you get a Special Enrollment Period to join, switch, or drop a Medicare drug plan once per quarter in the first 9 months of the year.
Related Medicare Savings Programs
Medicare Savings Programs (MSPs) are state programs that help pay Medicare Part A and Part B costs. Qualifying for an MSP often automatically qualifies you for Extra Help.
There are four MSP levels: Qualified Medicare Beneficiary (QMB), Specified Low-Income Medicare Beneficiary (SLMB), Qualifying Individual (QI), and Qualified Disabled and Working Individuals (QDWI).
What It Covers
- QMB: Pays Part A & B premiums, deductibles, coinsurance
- SLMB: Pays Part B premium only
- QI: Pays Part B premium (limited slots available)
- All MSPs automatically qualify you for Extra Help
What It Doesn't Cover
- MSPs don't cover Part D costs directly (Extra Help does)
- QI program has limited funding and may have waitlists
Extra Help Cost Comparison (2025)
| Cost Category | Without Extra Help | With Full Extra Help |
|---|---|---|
| Part D Monthly Premium | $0-$100+ (plan varies) | $0 (up to benchmark) |
| Annual Deductible | Up to $590 (2025) | $0 |
| Generic Drug Copay | Varies by plan tier | $4.50 per prescription |
| Brand-Name Drug Copay | Varies by plan tier | $11.20 per prescription |
| Coverage Gap Costs | 25% of drug cost | $0 |
✦ Important Exceptions & Special Situations
Automatic Qualification
You are automatically enrolled in Extra Help if you receive full Medicaid benefits, Supplemental Security Income (SSI), or are enrolled in a Medicare Savings Program. CMS will notify you by letter.
No application needed if you already receive Medicaid or SSI.
Deemed Eligible vs. Applied
Beneficiaries who are automatically enrolled ('deemed eligible') receive full Extra Help. Those who apply and qualify based on income/resources may receive full or partial Extra Help depending on their specific situation.
Annual Redetermination
SSA reviews your Extra Help eligibility each year. If your income or resources change, your level of assistance may change. You'll receive a notice if your status changes.
Benchmark Premium Plans
Extra Help pays your Part D premium up to the 'benchmark' amount for your region. If you choose a plan with a premium above the benchmark, you pay the difference.
✦ Recent Policy Updates
Inflation Reduction Act U2014 Expanded Extra Help
PassedThe Inflation Reduction Act (2022) expanded Extra Help eligibility to 150% of the Federal Poverty Level (previously 135%), bringing more low-income beneficiaries into the program starting in 2024.
$2,000 Part D Out-of-Pocket Cap (2025)
PassedStarting in 2025, Medicare Part D has a $2,000 annual out-of-pocket cap. Extra Help beneficiaries continue to pay only their small copays and are not subject to this cap.
Steps to Apply for Extra Help
Applying for Extra Help is free and can be done at any time of year. Here's how to get started:
Application Checklist
- Check your income against the current year's limits at ssa.gov
- Gather documents: Social Security card, bank statements, proof of income
- Apply online at ssa.gov/medicare/part-d-extra-help or call 1-800-772-1213
- Also apply for Medicare Savings Programs through your state Medicaid office
- Once approved, use your Special Enrollment Period to choose a Part D plan
- Contact your State Health Insurance Assistance Program (SHIP) for free help
✦ Frequently Asked Questions
David Haass
AuthorDavid Haass is a licensed insurance agent and Medicare specialist at MedicareFAQ.com.
Ashlee Zareczny
ReviewerAshlee Zareczny is the Compliance & Editorial Manager at MedicareFAQ.