What is Extra Help and how can it help you save on prescriptions?

The Extra Help program, also known as Low Income Subsidy, is a federal program ran through Social Security that helps reduce Part D prescription drug costs for low-income Medicare beneficiaries. It helps to reduce or eliminate copays, deductibles, premiums, and the Part D penalty. Beneficiaries with low income can apply through Social Security or may get it automatically through Medicaid and the Medicare Savings Program.

Medicare costs can add up! Even with Medicare coverage, there are a myriad of potential expenses including premiums, co-pays, co-insurance, and prescription drug costs. This means that some people with low, fixed income may go without care or needed medication.

Finding ways to save on Prescriptions can make a difference in health choices.

How Does Medicare Extra Help Work and Who Qualifies?

Also known as Low-income Subsidy (LIS), Extra Help is a federal program that helps low-income Medicare beneficiaries pay for out-of-pocket costs associated with Part D prescription drug coverage.

1. How Much Will You Pay for Medicare Part D Drugs with Extra Help?

Extra Help will reduce your Part D copays, monthly premiums, and annual deductibles.

Here is the breakdown of what you will pay if you receive Extra Help in 2026:

• Plan Premium: $0
• Plan Deductible: $0
• Generic Prescription Drug Copay: Up to $5.10
• Brand-name Prescription Drug Copay: Up to $12.65
• No Part D Penalty

If your total drug costs for the year reaches $2,100, you will pay $0 for each covered drug.

2. What Are the Income Limits for Medicare Extra Help?

To qualify for Extra Help, a person must be receiving Medicare, have limited resources and income, and reside in one of the 50 States or the District of Columbia. The Extra Help income limits chart below lists the max income and resources you can have to qualify.

2026 EXTRA HELP INCOME LIMITS CHART

This LIS chart shows the income limits for most states. See the Extra Help limits for Hawaii and Alaska at the end of this blog in our FAQs section.

How do I apply for Extra Help?

You apply for for Extra Help through Social Security or your state’s department of economic security (Medicaid) office. The quickest way to apply for Extra Help is online through the Social Security website here. You can also call Social Security at 1-800-772-1213 to apply by phone or make an appointment at the local Social Security office.

Social Security can take approximately 3 weeks to process and make a determination on your application.

What Income Is Included When Applying for Medicare Extra Help?

Not all sources of income needs to be included with your application.  Below is a list of income that needs to be included, as well as sources of income that can be excluded.

What Resources are Included When Applying for Medicare Extra Help?

The Extra Help program considers cash resources that are available to you when applying. These include cash on hand, funds in checking, and savings, as well as funds in retirement accounts and equity in certain investments.

Similar with income limits, your assets cannot be over the specified limits to qualify for any level of LIS.

Below is a list of resources that needs to be include and those that can be excluded.

After applying, Social Security will review the application and send a letter letting you know if you qualify. People who already have Medicaid do not need to apply for LIS and will automatically qualify and get a letter from CMS letting them know.

Extra Help Application Tip: When applying for LIS, you can opt to start the application process for the Medicare Savings Program (MSP) and the Social Security Administration will send the application data to the state Medicaid office.  MSP helps reduce the out-of-pockets costs of Medicare Part A and Part B.

Do you need to renew your Extra Help application?

Yes! Social Security will mail you an annual renewal reminder every year. You must renew your application every year and resubmit your income and resources.

Annual Extra Help Eligibility Requirements

You must continue to meet eligibility requirements each year to receive Extra Help. If you do not complete your review, or if your review shows you no longer qualify, then it will end December 31^st. 

If you originally qualified for Extra Help because you have Medicaid or the Medicare Savings Program (MSP) and you are still enrolled in one of these programs come the fall, then you will not have to do an annual review through Social Security. When you renew these programs the state will automatically inform Social Security that you are still enrolled.

What Happens if I lose Extra Help Coverage?

You will no longer receive low income subsidy to help reduce the costs of your prescriptions at the pharmacy if you lose Extra Help. Keep in mind, this does not cancel your Part D Prescription Drug plan. It will simply revert to the cost sharing and deductibles of your current Part D plan.

If you do lose Extra Help, then you should review the Part D Prescription Drug plan to determine your new out-of-pocket costs. You will get a 3 month Special Election Period to find a new plan if a different plan helps lower costs.

It is recommended to speak with a licensed agent to help you compare all plans in your area at once.

What are my enrollment options if I qualify for Extra help?

Qualifying for Extra Help gives you a Special Enrollment Period to enroll in or change plans outside of Medicare’s Annual Election Period (AEP). This special election period is for Part D Prescription Drug Plans and Medicare Advantage plans with Part D. 

You can also add or change a plan if you have any change in your Extra Help status. This includes if you lose eligibility, gain eligibility, or if your eligibility level changes. 

How can I get help applying or seeing if I qualify?

We regularly help beneficiaries with Extra Help questions and to see if they qualify. CONTACT US TODAY to speak with one of our Licensed Agent to get help.