What Extra Help Is

Extra Help (officially the Low Income Subsidy or LIS) is a federal program that pays most or all of the costs associated with Medicare Part D prescription drug coverage for low-income seniors and people with disabilities. Without Extra Help, Part D enrollees pay premiums, deductibles, and copays that can total thousands of dollars annually. Extra Help nearly eliminates these costs for qualifying individuals — making prescription medications affordable for seniors who would otherwise have to choose between medications and food or rent.

What Extra Help Pays in 2026

Full Extra Help (income at or below 135% FPL):

  • Monthly Part D premium: $0 (or the benchmark premium in your area)
  • Annual Part D deductible: $0
  • Copays: $4.50 for generic drugs, $11.20 for brand-name drugs
  • No coverage gap applies — continuous coverage throughout the year

Partial Extra Help (income 135–150% FPL): Reduced but still significant subsidy on premiums, deductible, and copays. Contact SSA for the specific amounts at your income level.

Who Qualifies — Income and Resource Limits

Income limit: 150% FPL. For 2026: single person = $22,590/year ($1,883/month); married couple = $30,630/year ($2,553/month). Resource limit: $17,910 for an individual, $35,730 for a married couple. Resources include bank accounts, stocks, and bonds — not your home, car, life insurance under $1,500, or burial funds. The IRA's phase-out of resource limits for Extra Help begins in future years — expanding eligibility further. If you're unsure whether your resources qualify, apply — SSA makes the official determination.

Automatic Enrollment — Who Gets It Without Applying

You are automatically enrolled in Full Extra Help (no application needed) if you: receive SSI; are enrolled in full Medicaid; or are enrolled in a Medicare Savings Program (QMB, SLMB, or QI). SSA automatically applies the benefit — you'll receive a purple or green notice confirming your Extra Help status and the effective date. If you think you should be automatically enrolled but haven't received a notice, call SSA at 1-800-772-1213 to check.

How to Apply

Apply through Social Security: online at ssa.gov/i1020, by calling 1-800-772-1213, or in person at your local Social Security office. The application takes about 30 minutes and asks for income and resource information. Processing takes 2–4 weeks. Extra Help is retroactive to the month of application for Part D costs incurred after enrollment. If you apply and are initially denied, you can appeal — income calculations are sometimes done incorrectly.

Combining Extra Help With Medicare Savings Programs

Extra Help and Medicare Savings Programs are complementary programs that together virtually eliminate Medicare costs for dual-eligible seniors: Medicare Savings Programs pay Part A and/or Part B premiums (saving up to $2,096/year in Part B premiums alone); Extra Help pays Part D premiums and most drug copays. Applied together, a qualifying senior with income around 100% FPL can have $0 in Medicare premiums and minimal prescription copays. Apply for both simultaneously — you can apply for Medicare Savings Programs through your state Medicaid agency while applying for Extra Help through Social Security. See Medicare Savings Programs.

Annual Renewal of Extra Help

Extra Help is not permanent without periodic confirmation. SSA reviews eligibility annually, typically sending an automatic redetermination notice. For recipients whose eligibility is based on SSI, Medicaid, or MSP status (which changes when those programs change), Extra Help status is updated automatically. For income-based Extra Help, SSA may ask you to confirm your income and resources annually. Respond promptly to any SSA correspondence about Extra Help to avoid interruption in your benefit.