Average annual value of Extra Help. Millions qualify but never apply. Let's find out if you're one of them.
Extra Help (officially called the Low Income Subsidy or LIS) is a federal program that helps Medicare beneficiaries pay for prescription drug costs under Part D. It covers some or all of your:
This is one of the most underused programs in all of Medicare. SSA estimates it's worth about $6,200 per person per year, and millions of people who qualify never apply. If you're on Medicare and struggling with drug costs, this should be the FIRST thing you check.
You automatically get Extra Help — no application needed — if you have Medicare AND any of the following:
If you're in any of these programs, CMS will send you a purple-colored notice confirming your Extra Help enrollment. You don't need to do anything — it's automatic.
Even if you're not in Medicaid, SSI, or an MSP, you can apply for Extra Help if your income and assets are below these 2026 limits:
| Requirement | Individual | Married Couple |
|---|---|---|
| Monthly Income Limit | $2,015/month | $2,725/month |
| Annual Income Limit (150% FPL) | $24,180/year | $32,700/year |
| Asset/Resource Limit | $16,590 | $33,100 |
| If You Qualify, You Pay | Max $12.65 brand-name / $5.10 generic per Rx | |
What counts as income: Social Security benefits, pensions, wages, interest, dividends. (There's a $20 monthly disregard automatically subtracted.)
What counts as assets: Savings accounts, stocks, bonds, mutual funds, retirement accounts, real estate (other than your home). Your home, car, personal belongings, life insurance, and burial plots do NOT count.
The income limits include a built-in $20 monthly disregard that SSA subtracts automatically. Also — if you're slightly over the limits, APPLY ANYWAY. Certain income types aren't counted, and SSA may find you eligible when you thought you weren't. It's free to apply and there's no penalty for being denied.
Answer these questions to get a rough idea of whether you might qualify. This is NOT an official determination — only SSA can make that call.
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Compare My Medicare Options — Free| Your Situation | Premium | Deductible | Brand-Name Copay | Generic Copay |
|---|---|---|---|---|
| Full Medicaid + QMB | $0 | $0 | $4.90 | $1.60 |
| Medicaid/SSI/MSP (auto-enrolled) | $0* | $0 | $12.65 | $5.10 |
| Applied and approved (income ≤150% FPL) | $0* | $0 | $12.65 | $5.10 |
| After catastrophic threshold ($2,100) | $0 copays for all covered drugs | |||
*$0 premium if enrolled in a benchmark plan. If your plan's premium exceeds the benchmark, you pay the difference.
If you're institutionalized (nursing home) or receiving home and community-based services through Medicaid, your copays are $0 across the board. Make sure your Part D plan knows your living situation.
Applying for Extra Help is free and there's no penalty for being denied. Here are your options:
Go to ssa.gov/i1020 and complete the application. It takes about 15-20 minutes. You'll need information about your income, assets, and current Medicare coverage.
Call 1-800-772-1213 (TTY: 1-800-325-0778) and request an Extra Help application. They can help you over the phone.
Bring the completed Form SSA-1020 (Application for Extra Help with Medicare Prescription Drug Plan Costs) to your local office.
Your State Health Insurance Assistance Program (SHIP) offers free, unbiased Medicare counseling and can help you apply.
SSA reviews Extra Help eligibility annually, usually at the end of August. If you're approved, you stay approved unless your circumstances change. If you're denied, you can reapply anytime — especially if your income or assets decrease.
Here's something most people don't realize: if you qualify for Extra Help, you get a Special Enrollment Period (SEP) every month to switch Part D plans. That means:
This is incredibly valuable. If your plan's formulary changes or a drug gets more expensive, you can switch right away.
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📞 Need Help Choosing a Medicare Plan?
Dr. Ed trusts Chapter — licensed advisors who help you find the right Medicare plan at no cost to you. No pressure, no upsell.
Compare My Medicare Options — Free