Extra Help: Lowering Medicare Drug Costs on a Limited Income

Prescription costs are one of the biggest worries for people on a fixed income. Extra Help is a Medicare program that lowers those costs for people with limited income and resources. Medicare.gov describes it as help paying Medicare drug coverage (Part D) premiums, deductibles, coinsurance and other costs. The Social Security Administration (SSA), which takes applications, also refers to it as "the subsidy."

If you're unsure whether you qualify, it's worth checking, because some common assets don't count. This guide covers who qualifies in 2026, what Extra Help pays, how to apply, and what happens after you're approved.

This is an independent guide and general information only, not financial, insurance or legal advice, and it is not affiliated with Medicare, CMS or SSA. For one-on-one help applying, contact your State Health Insurance Assistance Program (SHIP), which offers free counseling.

Who gets Extra Help automatically

Some people don't have to apply at all. Medicare.gov says you get Extra Help automatically if you get any of these:

• Full-benefit Medicaid coverage.
• Help from your state paying your Part B premiums through a Medicare Savings Program.
• Supplemental Security Income (SSI) payments from Social Security.

If that's you, you'll get a notice in the mail explaining how much you'll pay and, if you didn't already have one, which Medicare drug plan you've been placed in.

Income and resource limits for 2026

Everyone else applies, and eligibility depends on income and resources. Medicare.gov lists these limits for 2026:

• Individual: 2026 income limit of $23,940 and resource limit of $18,090, per Medicare.gov.
• Married couple: 2026 income limit of $32,460 and resource limit of $36,100, per Medicare.gov.

Income limits are higher in Alaska and Hawaii. For 2026, Medicare.gov lists Alaska's income limits at $29,925 for an individual and $40,575 for a couple, and Hawaii's at $27,540 and $37,335, with the same resource limits as elsewhere.

What counts matters as much as the totals. Medicare.gov's explanation of the 2026 resource limits counts money in checking, savings or retirement accounts, plus stocks and bonds. It does not count your home, one car, a burial plot, up to $1,500 set aside for burial expenses, furniture, or other household and personal items. Income that counts includes Social Security benefits, pensions, wages, annuities, rental income, veterans benefits and similar payments, while items such as SNAP benefits, housing assistance, home energy assistance and disaster assistance are not counted.

Medicare.gov says these limits may go up each year, and that you can reapply any time if your income or resources change, even if you didn't qualify before.

One limit on where the program works: Medicare.gov says Extra Help isn't available in Puerto Rico, the U.S. Virgin Islands, Guam, the Northern Mariana Islands or American Samoa. Those areas have other programs, and the State Medical Assistance (Medicaid) office can explain them.

What Extra Help pays

Medicare.gov has already posted what people with Extra Help will pay in 2027:

• Plan premium: $0 for 2027, per Medicare.gov.
• Plan deductible: $0 for 2027, per Medicare.gov.
• Up to $5.80 for each generic drug and up to $14.40 for each brand-name drug at a plan's participating pharmacies in 2027, per Medicare.gov.
• Once total drug costs reach $2,400 in 2027, including certain payments made on your behalf, Medicare.gov says you pay $0 for each covered drug.

Medicare.gov adds that for 2027, people who also have full Medicaid and are in the Qualified Medicare Beneficiary program pay no more than $4.90 per covered drug. For the current year, Medicare.gov's Medicare Savings Programs page says people who qualify through those programs pay no more than $12.65 in 2026 for each covered drug.

There is also a penalty benefit: Medicare.gov says you won't have to pay a Part D late enrollment penalty while you get Extra Help. Check your plan's own notices for the exact amounts that apply to you.

How to apply

SSA's Extra Help page says you can apply any time, before or after you enroll in Part D. You can apply online through SSA, or call 1-800-772-1213 (TTY 1-800-325-0778) and ask to set up an appointment to apply.

SSA suggests gathering these documents for you and your spouse first:

• Bank statements and tax returns.
• IRA or 401(k) account balances.
• Statements for pensions, veterans benefits, annuities and Railroad Retirement Board benefits.

There's a useful two-for-one built into the process. Medicare.gov says you can apply for Extra Help and Medicare Savings Programs at the same time: Social Security sends your information to your state to start a Medicare Savings Program application unless you tell it not to on the Extra Help application. Those state programs can help with Part B premiums and other Medicare costs.

If the forms feel daunting, Medicare.gov notes that your local SHIP can give free help applying.

After you qualify

Medicare.gov describes what happens next:

• If you don't already have a Medicare drug plan, you're enrolled in one automatically so you can get the savings. You can pick a different plan if you want.
• You keep Extra Help through December 31, even if your income changes during the year.
• If you still meet the limits the next year, you keep getting Extra Help. You get a notice only if you no longer qualify or are moved to a different plan for the next year.
• People with Medicaid or Extra Help may be able to change drug coverage once per month, rather than only at certain times of year.

If your pharmacy charges more than you expected, Medicare.gov suggests contacting your drug plan, which may ask for proof that you get Extra Help, and telling the plan how many days of medication you have left. You can also call 1-800-MEDICARE (1-800-633-4227; TTY 1-877-486-2048).

If you qualify for Extra Help or Medicaid but aren't in a drug plan yet, Medicare's Limited Income Newly Eligible Transition (LI NET) program provides temporary drug coverage. Medicare.gov says you may be able to get money back for covered drugs you paid for after you qualified for LI NET; keep your receipts and call LI NET at 1-800-783-1307.

A word on scams

Applications go through SSA, your state or official Medicare channels. Medicare.gov says Medicare will never call you to sell you anything or visit you at your home, and warns against joining a plan over the phone unless you called and asked for help. If someone calls offering to sign you up for Extra Help and asks for your Medicare Number or a payment, hang up and call SSA or 1-800-MEDICARE yourself.

Key takeaways

• Extra Help lowers Part D premiums, deductibles and copayments for people with limited income and resources.
• Full Medicaid, a Medicare Savings Program or SSI qualifies you automatically; others apply through SSA at any time.
• For 2026, Medicare.gov lists limits of $23,940 in income and $18,090 in resources for an individual; your home and one car don't count.
• For 2027, Medicare.gov lists copays of up to $5.80 for generics and $14.40 for brand-name drugs under Extra Help.
• Applying for Extra Help can start a Medicare Savings Program application with your state, and a SHIP counselor can help for free.

Sources

• Medicare.gov (CMS), Help with drug costs
• Social Security Administration, Apply for Medicare Part D Extra Help program
• Social Security Administration, Premiums: Rules for Higher-Income Beneficiaries
• Medicare.gov (CMS), Medicare Savings Programs
• Medicare.gov (CMS), Reporting Medicare fraud & abuse