Extra Help for Medicare Drug Costs: Who Qualifies Now
Extra Help is the Medicare program that can take a drug plan's premium and deductible down to $0 and cap each prescription at a few dollars. Open Enrollment runs until December 7, so this is a good time to check whether you qualify.
AT A GLANCE
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Drug costs are where Medicare surprises a lot of people. Even with a Part D plan, you can face a monthly premium, a deductible and a copay at every refill. Extra Help, sometimes called the Low-Income Subsidy, cuts most of that. Medicare.gov says you also won't owe a Part D late enrollment penalty while you get it.
Social Security says you can apply for Extra Help any time, before or after you join a Part D plan. You don't have to wait for Open Enrollment.
Do you qualify?
Medicare.gov lists these 2026 limits. Unlike the Medicare Savings Program limits, these are yearly income figures. Limits are different in Alaska and Hawaii, and Medicare.gov notes they may go up each year.
Your situation | Yearly income limit | Resource limit |
|---|---|---|
Individual | $23,940 | $18,090 |
Married couple | $32,460 | $36,100 |
To compare with a monthly check, $23,940 a year works out to about $1,995 a month. Social Security asks about income and resources for you and your spouse when you apply.
You may already have it
Medicare.gov says you get Extra Help automatically if you have any of these:
Full-benefit Medicaid
A Medicare Savings Program, where the state pays your Part B premium
Supplemental Security Income (SSI) from Social Security
If you're automatic, you'll get a notice in the mail saying how much you'll pay and naming your drug plan if you didn't already have one.
If you don't get a notice from Medicare or Social Security, you'll keep getting Extra Help and keep the same plan for next year.
What Extra Help pays for
Medicare.gov has already posted what people with Extra Help will pay in 2027:
Cost | With Extra Help in 2027 |
|---|---|
Plan premium | $0 |
Plan deductible | $0 |
Each generic drug at a participating pharmacy | Up to $5.80 |
Each brand-name drug at a participating pharmacy | Up to $14.40 |
After total drug costs reach $2,400 | $0 for each covered drug |
Full Medicaid plus QMB | No more than $4.90 per covered drug |
A quick example
Say you fill three generics and one brand-name drug each month in 2027. With Extra Help, the most you'd pay at a participating pharmacy is 3 × $5.80 plus $14.40, or $31.80 a month, with no premium and no deductible on top. Once total drug costs reach $2,400 for the year, your copays drop to $0.
The $2,400 figure counts certain payments made on your behalf, including Extra Help itself, so you can reach it faster than you might think. For comparison, Medicare.gov lists the 2026 out-of-pocket limit for Part D at $2,100.
How to apply
Gather paperwork for you and your spouse. Social Security lists bank statements and tax returns, IRA or 401(k) balances, and statements for pensions, veterans' benefits, annuities and Railroad Retirement benefits.
Apply online through Social Security, or call 1-800-772-1213 and say you want an appointment to apply for Part D Extra Help. Social Security says phone lines run Monday through Friday, 8 a.m. to 7 p.m., in most U.S. time zones, in English, Spanish and other languages.
Let it double as a state application. Medicare.gov says Social Security will send your information to your state to start a Medicare Savings Program application unless you tell them not to on the Extra Help form. Leave that alone if you'd like help with your Part B premium too.
Read the approval notice. If you didn't have a drug plan, Medicare will enroll you in one so you get the savings. You can choose a different plan.
Get free help if you're stuck. Your State Health Insurance Assistance Program, or SHIP, helps people apply at no cost.
If you're turned down, Medicare.gov says you can reapply any time your income or resources change.
Once you have it
You keep it through December 31
Extra Help lasts for the rest of the calendar year. Even if your income changes mid-year, you keep it through December 31. If you still meet the limits for the next year, it continues, and you'll only get a letter if you no longer qualify or you're moved to a different plan.
You can switch plans more often
Most people with Medicare can only change plans at certain times. Medicare.gov says people with Medicaid or Extra Help may be able to change drug coverage once a month. That matters if your plan drops a drug you take or a pharmacy you use leaves the network.
Use Open Enrollment anyway
Open Enrollment runs October 15 to December 7. Changes take effect January 1, and the plan must get your request by December 7. Even with Extra Help, it's worth checking whether another plan covers your drugs at a participating pharmacy near you.
If the pharmacy charges the wrong amount
If you qualify for Extra Help and think you're paying the wrong amount, Medicare.gov lists these steps:
Contact your drug plan. It may ask for proof that you get Extra Help before it corrects your costs.
Tell the plan how many days of medication you have left. The plan and Medicare will try to fix it before you run out.
Call 1-800-MEDICARE (1-800-633-4227), TTY 1-877-486-2048. Medicare can tell you your Extra Help level and help get your costs fixed.
Not in a drug plan yet?
Medicare's Limited Income Newly Eligible Transition program, LI NET, gives temporary Part D coverage to people who qualify for Extra Help or Medicaid but haven't joined a drug plan. If you paid for covered drugs after you qualified, you may get some money back. Keep your pharmacy receipts and call LI NET at 1-800-783-1307 (TTY 711), 8 a.m. to 7 p.m. Eastern.
Before you call
☐ Your Medicare card and Social Security number
☐ Bank statements and your most recent tax return, for you and your spouse
☐ IRA or 401(k) balances
☐ Pension, veterans' benefit, annuity or Railroad Retirement statements
☐ A list of the drugs you take, with doses, for comparing plans
☐ Pharmacy receipts, if you've been paying full price
WHAT TO DO THIS WEEK
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Related help
If you qualify for Extra Help, you may also qualify for help with your Part B premium. See our guide to Medicare Savings Programs. Insulin users in two states have extra options: the Minnesota Insulin Safety Net Program and Colorado's insulin affordability program.
Official sources
Last checked: October 23, 2026 (Medicare.gov Extra Help page with 2026 limits and 2027 costs; Social Security application page).
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