What Extra Help Covers and Who It's For

Extra Help is a federal program that pays part or all of your prescription drug costs if your income and savings fall 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 choose a specific plan to receive Extra Help — you can use it with any Part D plan that accepts it.

The program is run by Social Security and Medicare together. If you receive Supplemental Security Income (SSI), you are automatically considered for Extra Help each year. If you do not receive SSI, you will need to provide information about your income and resources to be reviewed.

Extra Help is separate from Medicaid, though some people receive both. You can have Extra Help even if you do not have Medicaid, and you can have Medicaid without Extra Help. The two programs work alongside each other to cover different costs.

Key Takeaways

  • Extra Help pays your Part D premium, deductible, and pharmacy costs if your income is below roughly $20,000 per year for an individual (the exact limit changes yearly and varies by state).
  • You must contact Social Security directly to request a review — Medicare does not process Extra Help decisions on its own.
  • If you receive SSI, Social Security reviews you automatically each year; if you do not, you must report your income and resources yourself.
  • The amount you pay at the pharmacy depends on your income level, ranging from nothing to a small copay for most drugs.
  • You can change your Part D plan once per year during the annual enrollment period, even while receiving Extra Help.

Income and Resource Limits That Determine Your Level of Help

Social Security uses two numbers to decide how much help you receive: your monthly income and your total resources (savings, investments, property other than your home). The income limit changes each year. For 2024, the limit is roughly $20,620 per year for an individual and $27,620 for a married couple living together, but these amounts increase slightly each January.

Resources are counted differently. You can have up to roughly $15,000 in savings and investments if you are single, or $23,000 if you are married. Your home does not count. A car does not count. Life insurance does not count. Only liquid assets — money in the bank, stocks, bonds, and similar holdings — are counted toward the resource limit.

If your income or resources are slightly above these limits, you may still receive some help. Social Security calculates a sliding scale: the closer you are to the limit, the more you pay out of pocket. You do not automatically lose all help the moment you cross the line.

How to Request a Review From Social Security

Contact Social Security directly to request that your income and resources be reviewed for Extra Help. You can call Social Security at 1-800-772-1213 (TTY 1-800-325-0778), visit your local Social Security office, or go online to ssa.gov to start the process. Social Security will ask you questions about your current income, living situation, and resources.

Have the following information ready when you contact them: your Social Security number, your date of birth, your current monthly income (from all sources — wages, pensions, Social Security, interest, rental income), and an estimate of your total savings and investments. If you are married, you will need the same information for your spouse.

Social Security will send you a notice within 30 days telling you whether you receive Extra Help and, if so, how much you will pay at the pharmacy. If you disagree with the decision, you can ask for reconsideration within 60 days of receiving the notice.

What You Pay at the Pharmacy Under Extra Help

How much you pay depends on your income level. If your income is very low, you may pay nothing — Social Security covers the full cost of your drugs. If your income is higher but still below the limit, you typically pay a small copay per prescription, usually between $1 and $4 for generic drugs and $3 to $9 for brand-name drugs. These copay amounts are set by Medicare and do not change during the year.

You also do not pay a deductible. In a regular Part D plan, you pay the full cost of drugs until you reach your deductible (usually $545 in 2024). With Extra Help, Social Security pays this amount for you, so you start paying only your copay from the first prescription.

Once you reach the coverage gap (sometimes called the "donut hole"), Extra Help continues to cover your drugs at the same copay rate. In a regular Part D plan, you would pay much more in the coverage gap. This is one of the biggest savings Extra Help provides.

Automatic Review If You Receive SSI

If you receive Supplemental Security Income (SSI), Social Security reviews your Extra Help status automatically every year in December. You do not have to do anything. Social Security already has your income and resource information because you receive SSI, so they use that to decide whether you still meet the limits.

You will receive a notice in the mail telling you whether your Extra Help continues, changes, or ends. If your circumstances change during the year — for example, you receive an inheritance or your income drops — you can contact Social Security to request an updated review at any time.

What Happens If Your Income or Resources Change

If you receive Extra Help and your income or resources increase during the year, you should report the change to Social Security within 10 days. This includes new income from work, a pension increase, or an inheritance. Reporting promptly helps avoid overpayment, which Social Security may ask you to repay later.

If your income or resources decrease — for example, you stop working or spend down savings — you can also report this change. Social Security will review you and may increase your Extra Help level. You do not have to wait until the annual review period to report a decrease.

Changes to your living situation also matter. If you move in with family, move to a nursing home, or change your marital status, tell Social Security. These changes can affect your income and resource limits.

Choosing and Changing Your Part D Plan While on Extra Help

You can enroll in any Part D plan that accepts Extra Help. Not all plans accept it, but most major plans do. When you are choosing a plan, check the plan's formulary (the list of drugs it covers) to make sure your current medications are included. Extra Help works the same way regardless of which plan you choose, so your copays will be the same.

Once you are enrolled, you can change plans once per year during the annual enrollment period (October 15 to December 7). If you change plans, your Extra Help follows you to the new plan automatically — you do not have to reapply. If your current plan stops covering one of your drugs, you can request an exception from the plan, or you can switch to a different plan that does cover it.

If you lose Extra Help because your income or resources increased, you can still enroll in a Part D plan, but you will pay the full premium and copays yourself. If you regain Extra Help later, you can switch back to a plan that accepts it without waiting for the annual enrollment period.

Frequently Asked Questions

Do I have to be on Medicare Part D to get Extra Help?

Yes. Extra Help only works with Part D prescription drug plans. If you are not enrolled in Part D, you should enroll first, then contact Social Security about Extra Help. If you miss the initial enrollment period when you first become may be able to access for Medicare, you may face a late penalty, so it is important to enroll as soon as you can.

What if I am married but my spouse does not have Medicare?

Social Security counts your spouse's income and resources toward your limits even if your spouse is not on Medicare. Your spouse's income and savings are included in the review. If your spouse is also on Medicare and Part D, your spouse can request Extra Help separately using their own income and resources.

Can I get Extra Help if I am not a U.S. citizen?

You must be a U.S. citizen or a may have access to noncitizen to receive Extra Help. may have access to noncitizens include lawful permanent residents (green card holders) and certain other immigration statuses. Contact Social Security to confirm whether your immigration status qualifies you.

What if Social Security denies my request for Extra Help?

You have the right to ask for reconsideration within 60 days of receiving the denial notice. You can provide new information about your income or resources, or explain why you believe the decision was wrong. If you disagree with the reconsideration decision, you can request a hearing before an administrative law judge.

Does Extra Help cover over-the-counter drugs or insulin?

Extra Help covers prescription drugs on your Part D plan's formulary. Over-the-counter drugs are not covered unless your doctor prescribes them and your plan includes them. Insulin is covered if it is on your plan's formulary. Some plans cover insulin at a lower copay than other drugs, so check your plan's details.