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Home > FAQs > How do I qualify for Medicare’s Extra Help?

How do I qualify for Medicare’s Extra Help?

Author: Louise Norris | Date Posted: December 1, 2025
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What is Medicare's Extra Help Program?

Lower-income Medicare beneficiaries may receive financial assistance through Medicare’s Extra Help program. If you have difficulty paying for prescriptions, the Extra Help program – also known as the Low-Income Subsidy (LIS) – can make prescriptions and plan premiums more affordable than they would be with Medicare Part D alone.

Before 2024, there were two different categories of Extra Help (full and partial) but that changed in 2024 under the Inflation Reduction Act. Everyone eligible for Extra Help now gets full Extra Help benefits.

Am I eligible for Extra Help?

Your income (from the prior year) and resources determine the level of help you receive. You’ll automatically receive Extra Help if you have both Medicare and Medicaid, are enrolled in a Medicare Savings Program, or receive Supplemental Security Income. Even if you don’t fit into one of those categories, you might qualify for Extra Help if you have limited income and assets.1

To be eligible for Extra Help, your income in 2025 cannot exceed $23,475 for an individual or $31,725 for a married couple living together. In addition, resources/assets must not exceed $17,600 for an individual and $35,130 for married couples2 (the financial limits are higher if you have dependents living with you, or if you live in Alaska or Hawaii; the limits are adjusted annually, usually in the early spring, after updated federal poverty level guidelines are published).

Resources do not include the value of your car or home, but do include stocks, bonds, and bank accounts.1 (The Social Security Administration has more details about what does and doesn’t count as resources).

Will Extra Help reduce my out-of-pocket costs?

Enrollees who receive full Extra Help in 2026 will pay no more than $5.10 for each generic drug and $12.65 for brand-name drugs.1 This is a valuable benefit that the Social Security Administration estimates is worth an average of about $6,200 per year.3 For Extra Help enrollees with income below the poverty level who are also enrolled in Medicaid, copays in 2026 are limited to $1.60 for generics and $4.90 for brand-name drugs.4

In addition to having lower copayments, Extra Help enrollees also have their Part D plan deductibles reduced or eliminated altogether (depending on their income). The federal government also pays Part D premiums on behalf of Extra Help enrollees – up to a benchmark amount (this amount is different in each state;5 the number of plans with no premium for Extra Help enrollees in each state ranges from one to four in 2026).6

Extra Help also eliminates the Part D late enrollment penalty for beneficiaries who would otherwise have to pay it.7

CMS estimated in 2023 that up to 2 million Medicare enrollees could be eligible for Extra Help but not enrolled.8 If you think you might be eligible, apply online or call Social Security at 1-800-772-1213.

Does Extra Help allow me to change my Part D coverage?

Yes. If you qualify for Extra Help, you can switch your Part D coverage up to once per month.9 This used to be a monthly enrollment opportunity, but it became monthly starting in 2025.10

Louise Norris is an individual health insurance broker who has been writing about health insurance and health reform since 2006. She has written hundreds of opinions and educational pieces about the Affordable Care Act and Medicare for healthinsurance.org and medicareresources.org.

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Footnotes

  1. ”Help with drug costs” Medicare.gov. Accessed Dec. 1, 2025 ⤶ ⤶ ⤶
  2. ”Help with drug costs” Medicare.gov. Accessed Sep. 15, 2025 ⤶
  3. ”Understanding the Extra Help with Your Medicare Prescription Drug Plan” Social Security Administration. Apr. 2025 ⤶
  4. ”What You Need to Know About Medicare Extra Help and Part D Costs in 2026” Pennsylvania Health Law Project. Sep. 26, 2025 ⤶
  5. ”Extra Help Benchmark Premium Amounts (US)” Medicare Rights Center. Jan. 4, 2025 ⤶
  6. ”A Current Snapshot of the Medicare Part D Prescription Drug Benefit” KFF.org. Oct. 7, 2025 ⤶
  7. ”Avoid late enrollment penalties” Medicare.gov. Accessed Dec. 1, 2025 ⤶
  8. ”Medicare Open Enrollment Partner Social Media Toolkit” Centers for Medicare & Medicaid Services. Accessed Sep. 15, 2025 ⤶
  9. ”Special Enrollment Periods” (Other Special Situations). Medicare.gov. Accessed Sep. 15, 2025 ⤶
  10. ”New Special Enrollment Periods (SEPs) for Dually Eligible and Extra Help-eligible Individuals” Centers for Medicare & Medicaid Services. Accessed Sep. 15, 2025 ⤶