Medicare Extra Help Program
Extra Help is a program that helps pay prescription drug costs for Medicare beneficiaries with low incomes and resources. Income limits change yearly. You may qualify for either a full or partial subsidy. Complete an online application with the Social Security Administration to see if you qualify.
- Written by Rachel Christian
- Edited By Lee Williams
- Updated: May 19, 2022
- 5 min read time
- This page features 8 Cited Research Articles
What Is the Medicare Extra Help Program?
Extra Help is a prescription drug savings program for Medicare beneficiaries with limited income and resources.
This program, also known as the Part D Low Income Subsidy, is administered by the Social Security Administration and the U.S. Centers for Medicare & Medicaid Services.
The amount you can save on your Medicare costs depends on your income and resources.
You can receive either a full subsidy or a partial subsidy.
- $0 premiums for drug coverage.
- $0 plan deductibles (or reduced deductibles if you receive a partial subsidy).
- No more than $9.20 in 2021 for each prescription your plan covers.
Who Qualifies for Extra Help?
You must have both limited income and limited resources to qualify for the Extra Help program.
In 2021, your annual income can’t exceed $19,320 for an individual or $26,130 for a married couple living together. This includes Social Security and pension payments.
However, not all cash payments count as income. For example, money from the Supplemental Nutrition Assistance Program (food stamps), earned income tax credit payments and educational grants don’t count toward the limit.
Other forms of assistance — including housing assistance, home energy assistance, disaster relief and assistance from others who help you pay your household bills — also don’t count as income.
To qualify for Extra Help, your resources can’t exceed $14,790 for an individual or $29,520 for a married couple living together.
- Real estate (other than your primary residence)
- Bank accounts, including checking, savings and certificates of deposit
- Investments, including stocks, bonds and mutual funds.
- Individual Retirement Accounts (IRAs)
Several resources don’t count toward the Extra Help limit, and therefore won’t impact your eligibility.
- Your home
- One car
- Jewelry and Furniture
- Life insurance policies
- Your personal possessions
- Burial plot
- Up to $1,500 for burial expenses if you have put that money aside
Keep in mind that you may no longer qualify for Extra Help if your income and resources change in the future.
How Much Help Can I Receive?
Depending on your income and resources, you may qualify for either partial or full Extra Help benefits.
| Income Limit | Asset Limit | Program | Copayments |
|---|---|---|---|
| Up to $1,610 for an individual ($2,177 for a married couple living together) per month | Up to $14,790 for an individual ($29,520 for a married couple living together) | Partial Extra Help
| 15 percent coinsurance or the plan copay, whichever is less
|
| Up to $1,469 ($1,980 for a married couple living together) per month. | Up to $9,470 ($14,960 for a married couple living together). | Full Extra Help $0 premium and deductible | $3.70 copay for generic drugs and $9.20 copay for brand-name drugs
|
If you’re dual-eligible for both Medicare and Medicaid or you’re enrolled in a Medicare Savings Program, you automatically qualify for full Extra Help benefits.
You’ll qualify for $0 prescription drug premiums. Copays at the pharmacy for Medicaid recipients range between $1.30 and $4 per prescription while copays for Medicare Savings Program enrollees range between $3.70 and $9.20 per prescription.
How Do I Apply for the Extra Help Program?
Some people automatically qualify for Extra Help. In these situations, you do not need to apply for the program.
- You have both Medicare and Medicaid
- You're in a Medicare Savings Program
- You receive Supplemental Security Income (SSI) benefits
Medicare will mail you a letter on yellow paper if you automatically qualify for Extra Help. Keep this for your records.
If you’re not enrolled in one of the programs above, you must apply to the Social Security Administration to receive Extra Help.
- Apply online
- Call Social Security at 1-800-772-1213 (TTY 1-800-325-0778)
- Apply at your local Social Security office
After you apply, Social Security will review your application before mailing you a letter to let you know if you qualify. You’ll receive a letter printed on green paper if you qualify.
After you qualify, you can pick your Medicare Part D drug plan. If you don’t select a plan, Medicare will automatically enroll you in one.
When you file your application for Extra Help, you can also apply for the Medicare Savings Programs. Social Security will send information to your state, and your state will then contact you and help you apply.
Medicare Savings Programs are joint federal and state programs that help people with limited resources and income pay other Medicare costs, including your Part A and Part B premiums and, potentially, your deductibles and copayments as well.
8 Cited Research Articles
- Social Security Administration. (2021, February). Understanding the Extra Help With Your Medicare Prescription Drug Plan. Retrieved from https://www.ssa.gov/pubs/EN-05-10508.pdf
- Medicare Rights Center. (2021). Extra Help Program Income and Asset Limits 2021. Retrieved from https://www.medicarerights.org/fliers/Help-With-Drug-Costs/Extra-Help-Chart.pdf?nrd=1
- National Council on Aging. (2020, November 10). Medicare Low Income Subsidy: Get Extra Help Paying for Part D. Retrieved from https://www.ncoa.org/article/medicare-low-income-subsidy-get-extra-help-paying-for-part-d
- Centers for Medicare & Medicaid Services. (2020, October 30). 2021 Resource and Cost-Sharing Limits for Low-Income Subsidy (LIS). Retrieved from https://www.cms.gov/files/document/lis-memo.pdf
- Centers for Medicare & Medicaid Services. (2020, May). What to do if you no longer automatically qualify for Extra Help with Medicare prescription drug costs. Retrieved from https://www.medicare.gov/Pubs/pdf/11215-No-Longer-Automatically-Qualify-Extra-He.pdf
- Medicare.gov. (n.d.). Deemed Status Notice. Retrieved from https://www.medicare.gov/basics/forms-publications-mailings/mailings/help-with-costs/extra-help-automatically-qualify-automatically-enroll
- Medicare.gov. (n.d.). Find your level of Extra Help (Part D). Retrieved from https://www.medicare.gov/your-medicare-costs/get-help-paying-costs/find-your-level-of-extra-help-part-d
- Medicare.gov. (n.d.). Lower prescription drugs. Retrieved from https://www.medicare.gov/your-medicare-costs/get-help-paying-costs/lower-prescription-costs