Medicare Extra Help: How to Qualify, Apply & Save on Drugs

Medicare Extra Help (officially called the Part D Low-Income Subsidy or LIS) is a federal program that pays most of your Medicare Part D prescription drug costs if you have limited income and resources. The benefit is worth approximately $5,700 to $6,200 annually per beneficiary, according to the Social Security Administration. In 2026, Extra Help recipients pay no monthly Part D premium (with benchmark plans), no Part D deductible, and a maximum of $5.10 per generic drug or $12.65 per brand-name drug. Once total out-of-pocket costs reach the 2026 catastrophic threshold of $2,100, all covered drugs are $0.

This guide explains Medicare Extra Help eligibility, how to apply, what the program covers, and how it interacts with Medicaid and the Medicare Savings Programs. Information comes from Medicare.gov, CMS, SSA, and the National Council on Aging.

2026 Extra Help income and resource limits

To qualify for Medicare Extra Help in 2026, your income and resources must fall below specific limits:

Income limits (150% of Federal Poverty Level for 2026):

• Single: $23,940 per year ($2,015 per month)

• Married couple living together: $32,460 per year ($2,725 per month)

• Higher income limits apply if you live in Alaska or Hawaii

Resource limits for full Extra Help benefit:

• Single: $16,590 (or $18,090 with $1,500 burial exclusion)

• Married couple: $33,100 (or $36,100 with $3,000 burial exclusion for couples)

Resources include checking and savings accounts, stocks, bonds, mutual funds, real estate other than your primary home, and retirement accounts. Resources NOT counted include your primary home, vehicle, life insurance policies, household goods, burial expenses up to $1,500 per person, and prepaid funeral arrangements.

Beneficiaries with income up to 150% of FPL who meet asset limits qualify for the full benefit. Those with income just above 150% may still qualify in special circumstances (Alaska/Hawaii residency, supporting dependents, work earnings).

For 2026, the federal poverty level is $15,960 for a single person and $21,640 for a married couple, which means Extra Help applies to people with up to about 150% of FPL.

How Medicare Extra Help reduces your drug costs

Extra Help dramatically lowers prescription drug costs in five ways:

1. No Part D plan premium (with benchmark plans). Extra Help recipients can enroll in any "benchmark" Part D plan at $0 monthly premium. Benchmark plans are those whose premiums are below the regional LIS subsidy amount ($15.20 in 2026). Non-benchmark plans charge a partial premium for LIS recipients.

2. No Part D deductible. While most Part D plans have annual deductibles of $590 or less in 2026, Extra Help waives this entirely. You pay copays only.

3. Capped prescription copays. Maximum drug costs with Extra Help in 2026:

• Generic drugs: $5.10 per prescription

• Brand-name drugs: $12.65 per prescription

• QMB recipients: Maximum $4.90 per drug

4. Catastrophic coverage at $2,100. Once your total annual out-of-pocket drug costs reach $2,100 in 2026, all covered prescriptions are $0 for the rest of the year. This is significant because the Inflation Reduction Act's $2,100 out-of-pocket cap applies to all Part D enrollees in 2026, but Extra Help recipients reach this threshold much faster due to lower copay structure.

5. No Part D late enrollment penalty. Anyone with Extra Help is exempt from the Part D late enrollment penalty, even if they delayed enrolling in a Part D plan when first eligible.

The total annual value depends on individual drug usage. For someone on multiple chronic medications, savings often exceed $6,000 annually.

Who automatically qualifies for Extra Help

You're automatically enrolled in Extra Help if you have any of the following:

• Full Medicaid coverage (also called "dual eligible" status)

• Supplemental Security Income (SSI) payments

• Enrollment in a Medicare Savings Program (MSP) including QMB (Qualified Medicare Beneficiary), SLMB (Specified Low-Income Medicare Beneficiary), or QI (Qualified Individual)

If you qualify automatically, you don't need to apply. SSA and CMS coordinate the enrollment, and you'll receive notification by mail when your Extra Help begins. You'll be enrolled in a Medicare Part D plan automatically if you don't choose one yourself, typically a benchmark plan in your area.

For Medicare Savings Program details, see our Medicare Savings Program guide (coming soon). For Medicaid eligibility, see our complete Medicaid guide.

How to apply for Medicare Extra Help

If you don't automatically qualify, you can apply through the Social Security Administration. The application is free. Three application methods:

Online application (fastest). Go to ssa.gov and search for "Extra Help" or visit ssa.gov/medicare/part-d-extra-help. The online application takes about 20 minutes. Most decisions arrive within 30 days.

Paper application. Request the SSA Form 1020 (Application for Extra Help with Medicare Prescription Drug Plan Costs) by calling 1-800-772-1213 or downloading from ssa.gov. Mail completed forms to SSA.

Phone or in-person. Call SSA at 1-800-772-1213 (TTY: 1-800-325-0778) to apply by phone, or visit your local SSA office. Note that SSA has been limiting walk-in visits since January 2025, so calling ahead to schedule is recommended.

What you'll need:

• Your Social Security number

• Your date of birth

• Your monthly income amount and sources

• A list of your resources (bank account balances, investments, real estate)

• Information about your spouse if applicable

SSA notifies you of the decision by mail within 30 days typically. If approved, your Extra Help benefit usually begins the month after the decision.

What happens after Extra Help approval

Once approved for Extra Help:

You can enroll in a Part D plan. You'll have a Special Enrollment Period (SEP) that lets you enroll in any Part D plan in your area, regardless of standard enrollment periods. Many Extra Help recipients are automatically enrolled in a benchmark plan if they don't choose one within a specific timeframe.

You can switch plans more easily. Extra Help recipients have SEPs to change Part D plans more frequently than non-LIS Medicare beneficiaries.

Your benefits are automatic at the pharmacy. Once enrolled in a Part D plan with Extra Help, your reduced copays apply automatically when you fill prescriptions. Your pharmacy sees your Extra Help status when verifying coverage.

Annual income redetermination. SSA reviews your income annually based on tax returns and other data. If your income changes significantly, your Extra Help level may adjust.

For ongoing prescription drug coverage details, see our Medicare Part D guide.