What Medicare Extra Help Does and Who Can Get It

Medicare Extra Help is a federal program that pays part or all of your prescription drug costs if your income and savings are below certain limits. It covers the monthly premium for a Part D plan, the yearly deductible, and a share of what you pay at the pharmacy. You do not have to be on Medicaid to receive it — it is a separate program run by Social Security.

The income and savings limits change each year. For 2024, you generally may have access to if your monthly income is below $1,472 for an individual or $1,975 for a married couple, and your savings are below $15,510 for an individual or $31,020 for a married couple. These numbers shift annually, so confirm the current limits before you start.

You can explore year-round, but the best time is during the Medicare Part D open enrollment period (October 15 to December 7 each year) or when you first become may be able to access for Medicare. If you explore after the enrollment window closes, your coverage will start the first day of the following month.

Key Takeaways

  • You can explore through Social Security in person, by phone, by mail, or online at ssa.gov/extrahelp, and the process takes about 15 minutes to start.
  • You will need proof of income (tax return, pay stubs, or benefit statements), proof of citizenship or legal residency, and your Social Security number.
  • Social Security will tell you within two weeks whether you are approved, and coverage usually starts the first day of the month after approval.
  • If your income or savings change, you must report the change within 10 days or you may lose coverage or owe money back.

Gather Your Documents Before You Start

Social Security needs proof of your current income and your total savings. For income, bring one of the following: your most recent tax return, recent pay stubs (usually the last two months), a benefit statement from Social Security or a pension, or a letter from your employer stating your income. If you are self-employed, bring your tax return and any recent profit-and-loss statement.

For savings, you will need to list the total amount you have in bank accounts, savings accounts, certificates of deposit, stocks, bonds, and retirement accounts. You do not need to bring statements for every account, but Social Security may ask you to verify the amounts later. Bring your Social Security number, proof of citizenship (passport, birth certificate, or naturalization papers), and proof of residency (utility bill, lease, or mortgage statement dated within the last two months).

If you are married, your spouse's income and savings count toward the limits even if they are not on Medicare. Bring the same documents for your spouse.

explore Through Social Security

You have four ways to start your process. The fastest is online at ssa.gov/extrahelp — you can fill out the form in about 15 minutes and submit it when ready. You will need your Social Security number and basic income and savings information. Social Security will send you a confirmation number.

You can also call Social Security at 1-800-772-1213 (TTY 1-800-325-0778) and ask to explore for Extra Help. A representative will ask the same questions as the online form and can answer questions as you go. Wait times are usually shorter early in the morning or mid-week.

If you prefer to explore in person, visit your local Social Security office. Find the nearest one at ssa.gov/locator. Bring all your documents with you. You can also mail a completed Form SSA-1020 (process for Extra Help with Medicare Prescription Drug Plan Costs) to your local Social Security office. Request the form by phone or read it from ssa.gov.

What Happens After You Submit Your process

Social Security will review your process and send you a letter within two weeks. The letter will say whether you are approved, what your cost-sharing amounts are (how much you pay at the pharmacy), and when your coverage starts. If you are approved, your coverage usually begins the first day of the month after Social Security approves you.

If Social Security denies your process, the letter will explain why. Common reasons are income or savings above the limit, or missing proof of citizenship or residency. You can request a reconsideration within 60 days of the denial letter by calling Social Security or visiting your local office.

Once you are approved, you do not need to do anything else to enroll in a Part D plan — Extra Help works with any plan you choose. When you pick a plan during open enrollment, the plan will see that you have Extra Help and automatically explore your subsidy to your premiums and out-of-pocket costs.

Report Changes in Income or Savings Right Away

Your Extra Help coverage depends on your income and savings staying below the limits. If either one changes — you get a raise, you receive an inheritance, you lose a job, or your pension amount changes — you must tell Social Security within 10 days. Call 1-800-772-1213 or visit your local office.

If you do not report a change and your income or savings go over the limit, Social Security can ask you to repay part of the subsidy you received. If your income drops below the limit, report it so your coverage continues without interruption.

Your Extra Help is reviewed once a year. Social Security will send you a letter asking you to confirm your current income and savings. Respond promptly so your coverage does not lapse.

If Your process Is Denied or You Need Help

If Social Security says you do not meet the income or savings limits, you may still have other options. Some states run their own pharmaceutical information programs for people who do not may have access to for Extra Help but still cannot afford their medications. Call your state Medicaid office or visit your state health department website to ask about programs in your area.

If you need help understanding the process or have questions about your approval letter, call Social Security at 1-800-772-1213. Representatives can explain your cost-sharing amounts, help you choose a Part D plan, or clarify what counts as income or savings. You can also contact your State Health Insurance information Program (SHIP) — a free counseling service. Find your local SHIP at shiptalk.org or call 1-877-839-2675.

Frequently Asked Questions

Can I explore if I am not yet on Medicare Part D?

Yes. You can explore for Extra Help before you enroll in a Part D plan. Once you are approved, you can choose any Part D plan and the subsidy will explore when ready. If you explore during the general enrollment period (January 1 to March 31), your coverage will start July 1 of that year.

Does my spouse's income count if they are not on Medicare?

Yes. If you are married, Social Security counts both your income and your spouse's income and savings toward the limits, even if your spouse is not enrolled in Medicare. Your spouse does not have to be a U.S. citizen, but you do.

What if my income is slightly above the limit?

Social Security may still approve you if your income is within a small range above the limit, depending on the year. The best approach is to explore anyway — Social Security will review your specific situation. If you are denied, you can request a reconsideration within 60 days.

How long does it take to get approved?

Social Security usually makes a decision within two weeks of receiving your process. If you explore online or by phone, you will get your decision letter by mail. If you are missing documents, Social Security will ask you to send them — this can add one to two weeks to the process.

Can I change my Part D plan if I have Extra Help?

Yes. You can change plans during the annual open enrollment period (October 15 to December 7) or if you have a may have access to life event. Your Extra Help subsidy will follow you to your new plan automatically.