Medicare Extra Help: Could You Qualify for Help With Prescription Drug Costs?
Prescription medications can be one of the biggest ongoing expenses for people on Medicare. But if you have limited income and resources, there may be a program that can significantly reduce what you pay for your Medicare prescription drug coverage.
It’s called Medicare Extra Help.
Extra Help is a federal program designed to help eligible Medicare beneficiaries with the cost of their Part D prescription drug coverage. It can help with premiums, deductibles, and prescription copayments or coinsurance. And if you qualify, you generally won't have to pay the Medicare Part D late enrollment penalty.
The important thing to know is this:
You may qualify even if you don't think you have a low enough income.
Let's break down how Extra Help works and who may be eligible.
What Is Medicare Extra Help?
Medicare Extra Help, sometimes called the Low-Income Subsidy (LIS), helps people with limited income and resources pay some of the costs associated with Medicare prescription drug coverage.
Depending on your situation, Extra Help can reduce or eliminate certain Part D costs.
For 2026, people who qualify can receive:
$0 premium for their qualifying prescription drug plan
$0 deductible
Reduced copayments for covered prescriptions
Protection from the Part D late enrollment penalty
For 2026, covered prescriptions generally cost no more than $5.10 for a generic drug or $12.65 for a brand-name drug under Extra Help. Once qualifying out-of-pocket drug costs reach $2,100, covered Part D prescriptions cost $0 for the rest of the year.
Your actual coverage and costs can depend on the Medicare drug plan you have and the medications you take.
Who Can Qualify for Extra Help?
Eligibility is generally based on your income and countable resources.
For 2026, the standard limits are:
Household | Annual Income Limit | Resource Limit |
Individual | $23,940 | $18,090 |
Married couple | $32,460 | $36,100 |
These aren't necessarily the final word on eligibility. Income limits can be higher in certain circumstances, including for people living in Alaska or Hawaii, and other factors can affect eligibility.
That's why I don't recommend automatically ruling yourself out because your income is slightly above the number you see online.
What Counts as a Resource?
This is one of the biggest areas of confusion.
When determining eligibility for Extra Help, certain financial resources count, including things such as:
Money in checking and savings accounts
Stocks
Bonds
Mutual funds
Certain retirement accounts
However, several things generally aren't counted, including:
Your home
One car
Household and personal items
A burial plot
Up to $1,500 per person set aside for burial expenses
Life insurance policies
So owning a home or having a vehicle does not automatically mean you are ineligible for Extra Help.
You May Already Qualify Automatically
Here's something many Medicare beneficiaries don't realize.
You may automatically receive Extra Help if you have Medicare and:
Full-benefit Medicaid
A Medicare Savings Program that helps pay your Part B premiums
Supplemental Security Income (SSI)
If you qualify automatically, Medicare or Social Security will send you a notice explaining your Extra Help benefits.
If you don't have Medicare prescription drug coverage, Medicare may enroll you in a Part D plan so you can receive the benefit.
What If You Don't Qualify Automatically?
You can apply for Extra Help through Social Security.
You don't have to wait for Medicare's Annual Enrollment Period. Applications can be made at any time.
You can apply:
Online through Social Security
By calling Social Security at 1-800-772-1213
Through a Social Security office
Social Security recommends having information about your income and financial resources available when you apply.
And if you were denied in the past, you may want to look again if your financial circumstances have changed.
A change in income, savings, marital status, or other circumstances can affect eligibility.
What Should You Do Next?
If you're struggling with prescription costs, don't automatically assume there isn't help available.
Here are a few questions to ask:
What is my current annual income?
How much do I have in countable financial resources?
Do I receive Medicaid or SSI?
Am I enrolled in a Medicare Savings Program?
Am I currently paying a Part D late enrollment penalty?
Have my income or financial circumstances changed since I last applied?
Medicare can be complicated. You don't have to figure it all out by yourself.
Have Medicare questions?
Medicare Melanie is here to help.
Schedule your free appointment with Medicare Melanie today by calling
(904) 582 - 8067
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