Extra Help (Part D Low-Income Subsidy): Who Qualifies, What It Covers, How to Apply
5 min read · Last updated August 12, 2026
- For 2026, the income limit to qualify for Extra Help is 150% of the Federal Poverty Level: $23,940 a year for an individual, $32,460 for a married couple living together.
- The resource (asset) limit is $18,090 for an individual and $36,100 for a married couple – and your home, one car, and burial funds don’t count toward that limit.
- Since January 2024, there’s no partial-subsidy tier anymore. If you qualify at all, you get the full subsidy – a lower copay than many seniors assume is possible.
- If you already receive Medicaid, SSI, or a Medicare Savings Program, you’re deemed eligible for Extra Help automatically – you don’t have to file a separate application.
Dolores is 68 and lives on a Social Security check of about $1,400 a month. Before a caseworker mentioned Extra Help at a senior center flu-shot clinic, she paid $45 a month for a single blood-pressure prescription. Under Extra Help, that same prescription costs her $4.90. Her next-door neighbor makes about $200 a month more and assumed that ruled her out. It didn’t.
In this article
What Extra Help is
Extra Help, also called the Part D Low-Income Subsidy (LIS), is a federal program that pays some or all of your Medicare Part D prescription drug plan costs – the monthly premium, the yearly deductible, and your copay at the pharmacy counter. It’s run by the Social Security Administration (SSA), not by your drug plan, which is why you apply through SSA rather than through your insurer.
Who qualifies
Two numbers matter: your income and your resources (what SSA calls countable assets).
For 2026, the income limit sits at 150% of the Federal Poverty Level: $23,940 a year for a single person, $32,460 for a married couple living together. That’s about $1,995 a month for one person – if your income is close to that line, apply anyway, because SSA excludes some income sources (like the first $20 of most monthly income) before comparing you to the limit.
The resource test is separate, and it trips people up because they count things that don’t count:
| 2026 limit | Individual | Married couple |
|---|---|---|
| Countable resource limit | $18,090 | $36,100 |
| Your home | Doesn’t count | Doesn’t count |
| One car | Doesn’t count | Doesn’t count |
| Life insurance | Doesn’t count | Doesn’t count |
| Burial funds (up to $1,500/person) | Doesn’t count | Doesn’t count |
What does count: money in checking and savings accounts, stocks, bonds, and a second car or property. A senior with $30,000 sitting in a savings account she’s kept “for emergencies” is over the limit even though her monthly income is well under it – both tests have to pass.
What it covers
If you qualify, Extra Help pays your Part D premium up to a regional benchmark amount, waives or reduces your yearly deductible, and caps your copay per prescription – typically a few dollars for a generic and somewhat more for a brand-name drug, rather than the percentage-of-cost you’d otherwise owe. Since a January 2024 rule change, there’s no partial-subsidy tier left. If you meet the income and resource limits, you get the full subsidy – not a reduced version of it.
You also don’t pay the Part D late enrollment penalty for as long as you have Extra Help, even if you enrolled in a drug plan later than you were first eligible.
Here’s what that looks like in real dollars for someone like Dolores. Without Extra Help, a Part D plan might charge her a $45 monthly premium, a $590 yearly deductible before coverage kicks in, and 25% coinsurance on brand-name drugs. With the full Extra Help subsidy, her premium drops to $0 for a benchmark-priced plan, her deductible disappears entirely, and her copay drops to a flat amount, commonly under $5 for a generic and under $13 for a brand-name drug, regardless of the drug’s actual cost. On a $150-a-month brand-name prescription, that’s the difference between paying roughly $37.50 in coinsurance and paying a flat copay under $13 – every month, for every covered drug on her plan’s formulary.
How to apply
You can apply for Extra Help directly with the Social Security Administration – online, by phone at 1-800-772-1213, or in person at a local SSA office. You’ll need your income and resource information handy; SSA will ask for the same categories shown in the table above.
You may not need to apply at all. If you already receive full Medicaid benefits, Supplemental Security Income (SSI), or help from a Medicare Savings Program (QMB, SLMB, or QI), SSA and your state automatically “deem” you eligible for Extra Help – no separate application required. Check your Medicare account or ask your State Health Insurance Assistance Program (SHIP) counselor to confirm you’re enrolled if you think this applies to you.
What seniors get wrong
The single most common mistake is assuming your income is too high without actually running the numbers. SSA doesn’t count the first $20 of most monthly income, and if you’re still working part-time, a chunk of your earnings gets excluded too. Run your actual numbers against the limits above before deciding you don’t qualify – a lot of people who assume they’re over the line are actually under it.
The second mistake is forgetting to reapply. Extra Help eligibility gets reviewed periodically, and if your income or resources change enough to put you over the limit, you can lose the subsidy without a dramatic notice – just a quieter letter that’s easy to overlook among other mail. Open every letter from SSA about your Medicare coverage the month it arrives.
The third mistake is not realizing help exists to actually fill out the application. A State Health Insurance Assistance Program (SHIP) counselor in every state helps people apply for Extra Help at no cost and has no incentive to sell you anything – unlike some phone lines that advertise “Medicare help” alongside a specific insurance product. Look up your state’s SHIP program by name rather than calling the first number that comes up in a search.
Extra Help and IRMAA sit at opposite ends of the same income scale. If your income has dropped enough that you might now qualify for Extra Help, it’s also worth checking whether you’ve moved out of an IRMAA surcharge bracket on your Part B or Part D premium.
Households already receiving Extra Help often qualify for other fixed-income support too. The Lifeline program offers a similar monthly discount on phone or internet service through the same kind of categorical eligibility.
Extra Help lowers what you pay toward your deductible and coinsurance, and those payments count toward the same yearly limit described in Medicare Part D’s $2,100 annual out-of-pocket cap, so the two programs work together rather than separately.
Frequently asked questionsDo I qualify if I’m still working part-time? Possibly. Social Security excludes a portion of earned income before comparing you to the Extra Help income limit, so working part-time doesn’t automatically disqualify you. Apply and let SSA run the actual calculation rather than assuming.
What happens if my income changes during the year? Report the change to Social Security. If your income or resources rise above the limit, your Extra Help may end, but SSA generally reviews eligibility on a periodic cycle rather than instantly – you won’t lose it the same day your income changes.
Does Extra Help cover all my prescriptions? It covers drugs on your Part D plan’s formulary at the reduced Extra Help copay. Drugs outside your plan’s formulary still require an exception request through your plan, the same as for any Part D enrollee.
Do I need to reapply every year? Not always. Some enrollees are reviewed automatically through their Medicaid, SSI, or Medicare Savings Program status. If you applied for Extra Help directly, SSA will send a redetermination notice when it’s time to confirm your income and resources again – respond to it promptly to avoid a gap in coverage.
