What Extra Help Is and Who Can Get It

Extra Help is a federal program that pays part or all of your Medicare prescription drug costs if your income and savings are low enough. The program covers the monthly premiums for a drug 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 can earn up to about $21,000 per year as a single person or $28,000 as a married couple and still be considered for Extra Help, though the exact amount depends on your state. Your savings (including bank accounts and stocks, but not your home or car) must be under about $15,000 for a single person or $30,000 for a married couple. These numbers increase slightly each year.

You must already be enrolled in Medicare Part B to use Extra Help. The program works with any Medicare prescription drug plan (Part D), so you choose which plan covers your medications.

Key Takeaways

  • You can explore through Social Security online, by phone at 1-800-772-1213, by mail, or in person at your local Social Security office.
  • You will need proof of income (tax return, W-2, or pay stub), proof of citizenship or legal residency, and a list of your current medications.
  • Social Security will tell you within two to three weeks whether you may have access to and how much help you will receive.
  • If your income or savings change during the year, you can report the change and your benefit amount may increase.
  • You can switch to a different drug plan once a year during the annual enrollment period, even if you are already receiving Extra Help.

Gather Your Documents Before You Start

Social Security will ask for proof of your income from the past year. Bring a copy of your most recent federal tax return, or if you do not file taxes, bring recent pay stubs (the last two months), a letter from your employer showing your wages, or a statement from Social Security showing your benefits. If you are self-employed, bring your tax return or business records.

You will also need to prove you are a U.S. citizen or lawful permanent resident. A birth certificate, passport, naturalization papers, or green card all work. If you do not have one of these, Social Security can help you find an alternative.

Have a list of your current medications ready, including the name of each drug and the strength (for example, metformin 500 mg). You do not need to know the exact cost — Social Security will look that up — but having the list helps them understand your situation and process your request faster.

explore Online, by Phone, or in Person

The fastest route is to explore online at ssa.gov/benefits/medicare. The form is called the "process for Extra Help With Medicare Prescription Drug Plan Costs" (form SSA-1020). You can fill it out and submit it without leaving home, and you will get a confirmation number right away.

If you prefer to speak with someone, call Social Security at 1-800-772-1213 (TTY 1-800-325-0778 for deaf and hard of hearing). They can take your information over the phone and mail you a form to sign and return. Wait times are usually shorter early in the morning or on weekdays.

You can also walk into your local Social Security office with your documents and explore in person. Find your office at ssa.gov/locator. Bring all your documents with you — do not mail originals, bring copies.

What Happens After You Submit Your process

Social Security will review your income and savings against the current year's limits. This usually takes two to three weeks. They will mail you a letter telling you whether you may have access to, how much help you will receive, and which drug plans you can use.

If you are approved, you do not need to do anything else to start receiving help. When you enroll in a Medicare drug plan, the plan will automatically know you have Extra Help and will charge you the reduced premium and cost-sharing amounts. If you are already enrolled in a drug plan when you are approved, the help starts the first day of the following month.

If Social Security denies your request, the letter will explain why. Common reasons are income or savings slightly above the limit, or missing documents. You can ask Social Security to reconsider, and you have the right to appeal.

Report Changes in Income or Savings During the Year

If your income drops during the year — because you retired, lost a job, or started receiving a pension — tell Social Security right away. You can report the change online, by phone, or in person using the same methods as your original process. If your new income is lower, your benefit amount may increase, and the change usually takes effect the following month.

The same applies if your savings drop below the limit. Social Security does not automatically check your bank account; you tell them when something changes. Reporting a change does not hurt you — it can only increase your help or keep it the same.

If your income goes up during the year, you do not lose Extra Help when ready. Your current benefit continues through the end of the calendar year. Social Security will reassess your case in the fall, and if you no longer may have access to, they will tell you before the next year begins.

Choosing and Switching Drug Plans With Extra Help

Once you are approved for Extra Help, you can enroll in any Medicare Part D drug plan. The plan does not have to be the cheapest one — choose the one that covers your medications at the lowest out-of-pocket cost to you. Use the Medicare Plan Finder at medicare.gov to see which plans cover your drugs and what you will pay.

You can change drug plans once a year during the annual enrollment period (October 15 to December 7). If you switch plans, your Extra Help moves with you automatically — you do not have to reapply. If your current plan stops covering one of your medications or raises its price, you can request a special enrollment period to switch outside the annual window.

If you are already enrolled in a drug plan when you are approved for Extra Help, you stay in that plan unless you choose to switch. You do not have to change plans just because you now may have access to for help.

Common Mistakes and How to Avoid Them

The most common mistake is not reporting a change in income or savings. Many people think they will lose Extra Help if they report a drop in income, but the opposite is true — reporting can only increase your help. If you do not report, you might be paying more than you should.

Another mistake is waiting too long to explore. Extra Help can start as early as the month you explore, but there is no penalty for explore late. However, if you are already in a drug plan without Extra Help, you may be paying full premiums and deductibles while you wait. explore as soon as you think you might may have access to.

Do not assume you do not may have access to because your income seems too high. The income limits are higher than many people expect, and they vary by state. The only way to know is to explore or call Social Security and ask.

Frequently Asked Questions

Can I explore for Extra Help if I am already on a drug plan?

Yes. If you are approved, Extra Help will start the first day of the following month, and your plan will automatically adjust your costs. You do not have to switch plans unless you want to.

What if my income is just slightly above the limit?

explore anyway. Social Security counts only certain types of income, and some income is excluded entirely (for example, Supplemental Security Income does not count). You may still may have access to even if your total income seems too high.

How long does Extra Help last once I am approved?

Extra Help continues as long as you stay on Medicare and your income and savings remain below the limits. Social Security reassesses your case each year, usually in the fall. If your situation changes, tell them right away.

Do I have to use a specific pharmacy if I have Extra Help?

No. You can use any pharmacy that accepts your Medicare drug plan. Extra Help works with the plan, not with a particular pharmacy. Check your plan's pharmacy network to see which pharmacies are included.

What if I am denied Extra Help and disagree with the decision?

You have the right to appeal. The denial letter will explain how to request reconsideration. You can ask Social Security to look at your case again, provide new documents, or request a hearing before an administrative law judge if you disagree with the reconsideration decision.