What Medicare Extra Help Is and How It Works

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

The amount of help you receive depends on your income and resources. If you may have access to, you might pay nothing for prescriptions, or you might pay a small copay per medication. The income and resource limits change each year, so even if you were turned down before, you may now meet the requirements.

Key Takeaways

  • You must be enrolled in a Medicare Part D drug plan to use Extra Help, and Social Security processes the request, not Medicare directly.
  • Your household income must be at or below 150 percent of the federal poverty line, which varies by family size and changes yearly.
  • You can have no more than $8,100 in countable resources if you are single, or $12,150 if you are married, though some assets like your home do not count.
  • You can request Extra Help by phone, mail, or online through Social Security, and the process usually takes two to four weeks.
  • If your income or resources change during the year, you can report the change and your benefit amount may adjust.

Income Limits for Extra Help in 2024

To receive Extra Help, your monthly household income must be at or below 150 percent of the federal poverty line. For 2024, that means a single person can earn up to approximately $1,968 per month, and a married couple can earn up to approximately $2,656 per month. These figures include income from Social Security, pensions, wages, interest, and other sources.

The exact limit depends on your family size and changes each January. If you are unsure whether your income qualifies, Social Security will calculate it when you request Extra Help — you do not need to determine this yourself first. If your income is slightly above the limit, you may still want to request it, because Social Security will make the final decision.

Resource Limits and What Counts

You can have no more than $8,100 in countable resources if you are single, or $12,150 if you are married. Resources include savings accounts, checking accounts, stocks, and bonds. However, your home, your car, and your household goods do not count. Life insurance also does not count toward the limit.

If you are married and only one spouse is requesting Extra Help, Social Security counts the resources of both spouses together. If you are close to the resource limit, you may want to ask Social Security exactly what counts before you request the program, because some assets are excluded and the calculation can be complex.

How to Request Extra Help

You request Extra Help through Social Security, not through Medicare. You have three options: call Social Security at 1-800-772-1213 (TTY 1-800-325-0778), mail a completed process, or explore online at ssa.gov/benefits/medicare. If you explore online, you can start the process when ready and finish it later — you do not have to complete it all at once.

When you request Extra Help, have your Social Security number, proof of citizenship or legal residency, and information about your income and resources ready. If you are married, you will need your spouse's Social Security number as well. Social Security will tell you what documents to send if you explore by mail.

After you submit your request, Social Security usually makes a decision within two to four weeks. You will receive a letter in the mail telling you whether you were approved and, if so, how much help you will receive. If you are approved, the benefit starts the month after Social Security approves you.

What Happens After You Are Approved

Once you are approved for Extra Help, you must be enrolled in a Medicare Part D drug plan to use the benefit. If you do not have a Part D plan, you can enroll in one during the general enrollment period (January 1 to March 31 each year) or during the Extra Help enrollment period. Social Security will send you information about how to enroll.

Your Extra Help benefit is tied to your Part D plan. If you switch to a different Part D plan, your Extra Help follows you to the new plan. You do not have to reapply for Extra Help when you change plans — Social Security automatically updates your information with Medicare.

Each year, you will receive a notice in the mail telling you whether your Extra Help continues or whether the amount has changed. If your income or resources change during the year, you can report the change to Social Security by phone or mail, and your benefit may adjust.

What to Do If Your Request Is Denied

If Social Security denies your request, the letter will explain why. Common reasons include income or resources above the limit, or not being a U.S. citizen or legal resident. You have the right to ask Social Security to reconsider the decision. You can request reconsideration by phone, mail, or online within 60 days of the denial letter.

If your income or resources have changed since you applied, you can reapply. Social Security will use your current information instead of the information from your first request. You can reapply at any time during the year.

How Extra Help Affects Other Benefits

Receiving Extra Help does not affect your Social Security benefits, Medicare Part A or Part B, or Medicaid (if you receive it). The program is designed to work alongside other benefits you may have. If you are on Medicaid, you may receive Extra Help as well — the two programs can overlap.

If you receive Supplemental Security Income (SSI), you are automatically considered for Extra Help each year. Social Security will send you a notice if you are approved. You do not have to request it separately if you are on SSI.

Frequently Asked Questions

Can I request Extra Help if I am still working?

Yes. Extra Help is based on your total household income, which includes wages, Social Security, pensions, and other sources. If your total income is at or below 150 percent of the poverty line, you can request it regardless of whether you are working.

What if my spouse does not want Extra Help but I do?

You can request Extra Help for yourself alone. Social Security will count your spouse's income and resources as part of your household, but your spouse does not have to be enrolled in a Part D plan or receive the benefit. Only you will receive the help.

Can I request Extra Help if I do not have a Part D plan yet?

Yes. You can request Extra Help before you enroll in a Part D plan. Once you are approved, you can then enroll in a plan and your Extra Help will start the following month. You do not have to wait to enroll in a plan first.

What if my income goes above the limit after I am approved?

If your income increases during the year, you should report it to Social Security. Your Extra Help may be reduced or end, depending on how much your income increased. Social Security will send you a new notice explaining your benefit.

How long does Extra Help last?

Extra Help continues as long as you remain enrolled in a Medicare Part D plan and your income and resources stay at or below the limits. Each year, Social Security reviews your case and sends you a notice about whether your benefit continues. You do not have to reapply every year unless your circumstances change.