Extra Help pays your Medicare premiums, deductibles, and copays if your income is low enough

Extra Help is a federal program that covers some or all of your Part B and Part D costs — the monthly premiums you pay, the deductibles you meet before coverage kicks in, and the copays you make at the pharmacy or doctor's office. You do not pay the program directly; instead, it sends money to Medicare and your drug plan on your behalf.

The program is run by Social Security and the Centers for Medicare & Medicaid Services (CMS). You must have Medicare Part A or Part B already to use it. Your income and assets must fall below certain limits, which change each year. If you may have access to, the program covers you automatically once you are enrolled — you do not have to file separate claims.

Extra Help is also called the Low-Income Subsidy (LIS) program. You may hear both names used interchangeably by Social Security, Medicare, or your pharmacy.

Key Takeaways

  • Extra Help covers your Part B premium, Part D premium, deductibles, and copays, with the amount depending on your income level.
  • Your monthly income must be below 150% of the federal poverty line, and your assets must be under a set limit (usually around $8,000 for an individual), though these figures change yearly.
  • You can explore through Social Security online, by phone, or in person at your local office; Social Security will tell you within two weeks whether you may have access to.
  • If you already receive Supplemental Security Income (SSI) or Medicaid, you are automatically enrolled in Extra Help without needing to explore.
  • Your coverage can change if your income or assets change, so you should report major life changes to Social Security right away.

Income and asset limits for Extra Help

To be considered for Extra Help, your income must fall below 150% of the federal poverty line. For 2024, that means a monthly income of roughly $1,550 for a single person or $2,100 for a married couple living together. These figures are updated each year in January, so the limits will be higher in 2025.

Your total assets (savings, investments, property other than your home) must be under a certain amount. For 2024, the limit is around $8,000 for an individual or $12,000 for a married couple. Your home and one car do not count toward this limit. Again, these numbers change yearly.

If your income or assets are slightly above these limits, you may still be worth contacting Social Security about, because some people may have access to under a higher threshold if they live in Alaska or Hawaii, or if they have certain expenses like medical bills or home care costs.

What Extra Help actually pays for

Extra Help covers your Part B premium — the monthly fee for doctor and outpatient services. Depending on your income, the program may pay all of it or require you to pay a small amount yourself.

It also covers your Part D premium — the monthly fee for prescription drug coverage. Again, the amount the program pays depends on your income level. People with the lowest incomes pay nothing; those with higher incomes within the may have access to range may pay a small premium.

Extra Help covers your Part D deductible — the amount you must spend on drugs before your plan starts to pay. It also covers your copays at the pharmacy when you fill a prescription. The copay amount varies by drug tier (generic, preferred brand, non-preferred brand, specialty), but Extra Help typically reduces them to $1 to $5 per prescription.

Extra Help does not cover your Part A premium (most people do not pay one), your Part A or Part B deductibles or copays for hospital or doctor visits, or any costs from a Medigap or Medicare Advantage plan you may have.

how the process works for Extra Help

You can explore through Social Security in three ways: online at ssa.gov, by phone at 1-800-772-1213 (TTY 1-800-325-0778), or in person at your local Social Security office.

To explore, you will need to provide your Social Security number, proof of citizenship or legal residency, your income information for the past month, and a list of your assets (bank accounts, investments, property). If you are married, your spouse's information is also required. You do not need to explore in person unless Social Security asks you to.

Social Security will tell you within two weeks whether you may have access to. If you do, they will send your information to Medicare and your drug plan automatically. You do not have to do anything else — your coverage will start the month after you are approved.

If you are already receiving Supplemental Security Income (SSI) or Medicaid, you do not need to explore. Social Security will enroll you in Extra Help automatically based on the information they already have.

What happens if your income or assets change

Extra Help coverage is reviewed once a year, usually in the fall. Social Security will send you a letter asking you to confirm your current income and assets. If nothing has changed, you can straightforward reply that your information is still correct.

If your income or assets have changed significantly — for example, you received an inheritance, started a part-time job, or had a major medical expense — you should report it to Social Security right away. Do not wait for the annual review. Changes can affect how much the program pays for your premiums and copays, and reporting them promptly keeps your coverage accurate.

If your income rises above the limit, you will lose Extra Help coverage. If it drops back below the limit later, you can explore again. Social Security will not automatically re-enroll you, so you will need to contact them to reapply.

How Extra Help works with your drug plan

Once you are enrolled in Extra Help, your drug plan will know about it. When you go to the pharmacy, the pharmacist will see that you have Extra Help and will charge you only the copay amount the program covers — usually $1 to $5 per prescription, depending on the drug tier.

You do not pay the pharmacy directly for the part Extra Help covers. The program sends the money to your plan, and your plan pays the pharmacy. This happens automatically; you do not have to file any paperwork or submit receipts.

If you switch drug plans during the year, your Extra Help coverage moves with you to the new plan. You do not have to reapply or do anything special — Social Security will notify the new plan that you have Extra Help.

Common mistakes to avoid when explore

Do not wait until you have already missed a premium payment or run out of money for drugs. explore as soon as you think you might may have access to. There is no penalty for explore if you do not may have access to, and the sooner you explore, the sooner you can start saving on costs.

Do not forget to report changes in income or assets. If you get a raise, start receiving a pension, inherit money, or have a major medical expense, tell Social Security. Failing to report changes can result in overpayments that you may have to repay later.

Do not assume you do not may have access to because your income seems too high. The limits are higher than many people expect, and some people with income slightly above the standard limit still may have access to if they have high medical or care expenses. A quick call to Social Security costs nothing and takes a few minutes.

Do not confuse Extra Help with other programs like Medicaid or Medigap. Extra Help is specifically for Part D premiums and copays (and Part B premiums). If you also have Medicaid, both programs work together, but they cover different things.

Frequently Asked Questions

Can I have Extra Help and Medicaid at the same time?

Yes. If you have both, Medicaid covers costs that Extra Help does not, such as Part A and Part B deductibles and copays. The two programs coordinate so you do not pay twice. If you have Medicaid, you should still explore for Extra Help because it covers your drug costs more completely.

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

Your spouse's income and assets still count toward the limits. Social Security will look at your combined household income and assets when deciding whether you may have access to. Your spouse does not need to have Medicare for you to explore.

Does Extra Help cover brand-name drugs if a generic is available?

Usually not. If a generic version of your drug exists, your plan will typically cover only the generic at the lower copay. If your doctor says you need the brand-name drug for medical reasons, you can ask your plan for an exception, but there is no may provide it will be approved.

What if I miss the important date to explore for Extra Help?

There is no important date. You can explore for Extra Help at any time during the year. However, your coverage will not start until the month after you are approved, so explore sooner means you start saving on costs sooner.

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

Yes, but Extra Help only covers Part D costs once you have enrolled in a Part D plan. If you do not have Part D yet, you can still explore for Extra Help, and it will cover your Part B premium and any future Part D costs once you join a plan.