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Extra Help for Medicare Part D: Who Qualifies and How to Apply
Extra Help is a federal program that lowers what you pay for Medicare drug coverage. If your income and savings are under the limits, you can pay $0 for your Part D premium and deductible, plus a small copay on each prescription. It is also called the Low Income Subsidy, and you apply through Social Security, not through an insurance company. We help Colorado residents sort out the Part D side of this every year, and this guide covers what you need to know: the limits, the paperwork, the plan choice that follows and the mistakes that cost people money.
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- Extra Help pays Part D premiums, deductibles and part of your copays if your income and resources are under the limits. In 2026 that means under $23,940 in income and $18,090 in resources for one person, or $32,460 and $36,100 for a married couple.
- You qualify automatically if you have Medicaid, SSI or a Medicare Savings Program. Everyone else applies with Social Security online or at 1-800-772-1213.
- Social Security estimates the benefit is worth about $5,700 a year.
- Extra Help does not pay your Part B premium. Medicare Savings Programs do, and you can apply for both at once.
- Your plan choice still matters: the premium subsidy is capped at a regional benchmark, so a pricier plan can leave you with a bill.
Table of Contents
- What Extra Help does for your drug costs
- Who qualifies: the 2026 limits
- Automatic qualification
- How to apply for Extra Help
- What happens after you are approved
- Does Extra Help pay the Part B premium?
- If you are turning 65 or new to Medicare
- Extra Help and the 2026 out-of-pocket cap
- Mistakes that cost people Extra Help
- Our perspective
- Get a plan that fits your Extra Help
- FAQ
- Sources
What Extra Help does for your drug costs
Medicare Part D is the prescription drug coverage that comes through a private insurance plan. Even with a good plan you normally pay a monthly premium, a deductible and a copay or coinsurance at the pharmacy. Extra Help, per Medicare, helps pay those costs if your income and resources are limited.
For 2027, Medicare lists the benefit this way: $0 for your drug plan premium and deductible, and up to $5.80 for each generic and $14.40 for each brand-name drug. In 2026, the copays are up to $5.10 for generics and $12.65 for brand-name drugs, and there is no deductible.
The benefit is big. If you take several maintenance medications, the difference between full retail cost-sharing and a few dollars a fill adds up quickly. That is why the Social Security Administration puts the value at roughly $5,700 a year for an eligible person.
One rule of the program reaches back a few years. Since January 1, 2024, anyone whose Extra Help starts on or after that date gets the full subsidy. The Inflation Reduction Act raised the income ceiling for the full benefit from below 135% to below 150% of the federal poverty level, raised the resource limits and removed the old lower tier. Many people who were turned down or got only partial help before 2024 now qualify for the full benefit. If that is you, apply again.
Who qualifies: the 2026 limits
Eligibility rests on two numbers: your yearly income and your countable resources. Medicare publishes the 2026 limits:
2026 limit Individual Married couple Annual income $23,940 $32,460 Resources $18,090 $36,100Source: Medicare, Help with drug costs. The resource limits include a burial exclusion. The limits are higher in Alaska and Hawaii, and they are updated each year, so check the current figures before you decide you are over.
What counts as a resource
People rule themselves out here more than anywhere else, so it pays to be exact. According to Medicare’s drug coverage guide, countable resources include money in checking, savings or retirement accounts, stocks, bonds and real estate other than your primary home. Not counted: your home, your personal belongings, one car and burial plots.
A worked example: a Castle Pines retiree has $14,000 in savings, $3,000 in checking and owns her home and one car. Her countable resources are $17,000, under the $18,090 individual limit. If her income is also under $23,940, she is within the 2026 limits even though she owns a house. Many homeowners assume the house disqualifies them. It does not.
Married couples
If you are married and living together, you give financial information for both spouses, and the couple limits apply. A spouse’s pension or savings counts even if only one of you needs the drug coverage.
Automatic qualification
Some people never need to apply. Medicare says you automatically qualify if you have Medicaid, Supplemental Security Income (SSI) or help from a Medicare Savings Program. Social Security’s own rules confirm that people who qualify for the Medicare Savings Program levels called QMB, SLMB or QI get Extra Help automatically, which covers everything except a minimal copayment.
Two practical points:
- You get a notice if you qualify automatically. Keep it. It tells you the level of help you have.
- If you lose Medicaid, SSI or Medicare Savings Program status, your automatic Extra Help can end too. Reapply with Social Security if your income and resources still fit. Medicare notes you can reapply any time your circumstances change.
How to apply for Extra Help
Social Security runs the application. You can apply online at SSA.gov or call 1-800-772-1213. The application is free. Nobody needs to be paid to file it for you.
Step 1: Gather your numbers
Social Security asks you to have these ready, for yourself and your spouse:
- Bank statements
- Tax returns
- Statements for IRAs and 401(k) accounts
- Statements for pensions, Veterans’ benefits, annuities and Railroad Retirement Board benefits
Where people go wrong: they report only one account, forget a small IRA, or leave out a spouse’s pension. An incomplete form slows the decision and can lead to a wrong answer. Put every account on a single sheet before you start.
Step 2: Submit the application
Fill it in online, or call and answer the questions with a representative. Answer every question about income and resources, even the ones that seem not to apply.
Step 3: Ask about Medicare Savings Programs at the same time
Social Security and CMS note that you can apply for Extra Help and for Medicare Savings Programs at the same time. Those programs help with costs beyond drugs, and qualifying for one makes Extra Help automatic. We cover the four programs in more detail in our guide to Medicare Savings Programs for low-income seniors.
Step 4: Watch for the letter
Social Security or Medicare sends a notification letter with the decision. Read it, keep it and note the date your help starts.
What happens after you are approved
If you are approved and not yet in a Part D plan, Medicare automatically places you in a drug plan so you have coverage for the rest of the calendar year. The Social Security Administration says your Part D coverage should begin within two months of your enrollment in Extra Help, per its guidance on Part D with Extra Help.
An automatic assignment gets you covered. It does not mean the plan fits your medicines. Two things to check as soon as you can:
- Your drugs. Every plan has a formulary, its list of covered drugs. A plan chosen at random may not cover your prescriptions, or may require prior approval. Our overview of what Part D is and how formularies work explains the terms.
- Your pharmacy. Plans have preferred and standard pharmacies. Check that yours is in the network.
The benchmark rule
The premium subsidy has a ceiling. Social Security’s rules explain that the subsidy is limited to the regional benchmark set by CMS, so if you choose a plan whose premium is higher, you can owe the difference. Plans at or below the benchmark can have a $0 premium for people with full Extra Help. The benchmark is set by region, so the plans that cost you nothing in Colorado are not the same as those in another state.
Does Extra Help pay the Part B premium?
No. Extra Help covers prescription drug costs only. The Part B premium, for doctor visits and outpatient care, is paid by Medicare Savings Programs. The Social Security Administration describes them like this: QMB pays Part A and Part B premiums plus cost-sharing, SLMB and QI pay Part B premiums only, and QDWI pays Part A premiums only (SSA POMS).
The stakes are real. The standard Part B premium in 2026 is $202.90 a month, $17.90 more than in 2025. Someone who qualifies for Extra Help may also qualify for a Savings Program, which is why we suggest applying for both. Our Medicare Cost Calculator gives you a view of your overall monthly costs before you decide.
If you are turning 65 or new to Medicare
Extra Help works with Medicare, so you need Part A or Part B to use it. If you are about to turn 65, the order of steps matters:
- Check when your own Medicare window opens with the Medicare Enrollment Timeline.
- Enroll in Medicare.
- Apply for Extra Help as soon as you are eligible, rather than waiting until you have a first pharmacy bill.
- Choose a Part D plan or a Medicare Advantage plan with drug coverage.
Extra Help also changes how you think about the Part D late enrollment penalty. If you go without creditable drug coverage, you may owe a penalty for as long as you have Part D. Our Part D Penalty Calculator shows how it is figured, and our guide to late enrollment penalties explains how to avoid one.
Extra Help and the 2026 out-of-pocket cap
Part D now has a yearly out-of-pocket cap for everyone, and the old coverage gap, the “donut hole,” is gone. We explain the change in what replaced the donut hole and the cap in $2,100 cap and Part D. If you receive Extra Help, your costs are already far below that cap, because your copays are limited to a few dollars per drug.
That does not mean the plan you choose is irrelevant. It means you choose on coverage and convenience, not on the fear of a large bill.
Mistakes that cost people Extra Help
- Skipping the application because you own a home. The home does not count.
- Leaving out a spouse’s accounts. Couples report both.
- Not reapplying after a change. If you were turned down before 2024, or your income has dropped, apply again.
- Ignoring the letter. The notice tells you your level of help. Keep it for the pharmacy and your plan.
- Choosing a plan above the benchmark. The premium difference comes out of your pocket.
- Not reviewing each fall. Plans change formularies and premiums every year. Your Extra Help can continue while your plan quietly stops covering a drug.
Our perspective
Most people who call us about Extra Help have the same worry: that the paperwork is a maze and they will be turned down. The application itself is not the hard part. Choosing the plan afterward is where we see people lose money.
Extra Help lowers your cost, but it does not choose a formulary, check your pharmacy or tell you when a plan’s premium goes above the benchmark. As independent, licensed brokers, we compare plans across multiple carriers against your actual prescriptions, and we do it for Colorado residents who want someone local to call.
The support does not stop at enrollment. We help with annual reviews each fall, with claims questions during the year, and with appeals and grievances if a plan denies a drug. Our service has no direct cost to you.
Zach
Get a plan that fits your Extra Help
If you qualify, or think you might, we can look at your prescription list, compare Part D plans and Medicare Advantage options that include drug coverage, and explain how your Extra Help level interacts with each. We also offer annual enrollment support and appeals and grievances help for later.
Start with our Medicare Part D plans in Castle Pines page, or see everything we do on our services page. If you want to understand your options first, our Medicare Guide answers common questions.
FAQ
Is Extra Help the same as the Low Income Subsidy?
Yes. Extra Help is the program’s everyday name, and Low Income Subsidy (LIS) is the formal one. Both describe the same Medicare benefit that lowers Part D premiums, deductibles and copays for people with limited income and resources.
Can I get Extra Help if I own my home?
Yes. Your primary residence is not counted as a resource. Social Security’s guidance also excludes personal belongings, one car and burial plots. Savings, retirement accounts, stocks, bonds and other real estate do count.
How long does it take for Extra Help to start?
Social Security says your Part D coverage should begin within two months of your Extra Help enrollment. You will get a letter with the decision. If you are approved and not already in a drug plan, Medicare places you in one so you have coverage for the rest of the year.
What if I am denied?
You can reapply at any time if your income or resources change. The rules also changed in 2024, so an earlier denial does not mean you are out. If your situation is unclear, a licensed broker can help you review it and explain next steps, including appeals.
Sources
- Help with drug costs, Medicare
- Apply for Medicare Part D Extra Help program, SSA
- Understanding the Extra Help With Your Medicare Prescription Drug Plan, SSA
- Your Guide to Medicare Drug Coverage, Medicare
- SSA POMS HI 03001.020, Eligibility for Extra Help
- SSA POMS HI 03001.005, Medicare Part D Extra Help
- SSA POMS HI 00815.024, SSA’s Role in Medicare Savings Programs
- Out-of-Pocket Health Costs and Financial Assistance for Medicare Beneficiaries in 2026, NASW