Extra Help pays part of your Medicare prescription drug costs
Extra Help is a federal program that covers some or all of your costs for Medicare Part D prescription drugs — the monthly premiums, yearly deductibles, and copayments when you fill prescriptions. You do not pay the program directly; instead, it sends money to your drug plan on your behalf, and your out-of-pocket costs drop.
The program is run by Social Security and the Centers for Medicare & Medicaid Services (CMS). It is separate from Medicaid, though some people are enrolled in both. Your income and resources determine how much help you receive — people with lower incomes get more coverage.
Extra Help is not automatic. You have to be enrolled in a Medicare Part D plan to use it, and you have to tell Social Security you want Extra Help. Many people who may have access to do not know the program exists, so it is worth checking whether you meet the income and resource limits.
Key Takeaways
- Extra Help covers your Part D premiums, deductibles, and copayments, with the amount depending on your income and resources.
- You must be enrolled in a Medicare Part D prescription drug plan to use Extra Help; the program does not work with Original Medicare alone.
- Your household income must be at or below 150% of the federal poverty line, though the exact limit changes each year.
- You explore through Social Security — either online at ssa.gov, by phone at 1-800-772-1213, or in person at your local Social Security office.
- If you are approved, Extra Help coverage starts the month after Social Security processes your request.
Income and resource limits for Extra Help
To be considered for Extra Help, your household income must be at or below 150% of the federal poverty line. The poverty line changes each year. For 2024, the income limit for a single person is roughly $1,968 per month, and for a married couple it is roughly $2,656 per month — but these figures vary by state and change annually, so you should check the current year's limit.
Social Security also looks at your resources — the money and property you own. The resource limit is $15,510 for an individual and $31,020 for a married couple as of 2024. Resources include bank accounts, stocks, and bonds, but not your home, car, or personal belongings. If you are over the limit, you do not automatically disqualify; Social Security will tell you whether you still meet the requirements.
If your income or resources are close to the limit, it is still worth checking. Some people may have access to for what is called "deemed" Extra Help, which means Social Security counts your income differently if you are receiving certain benefits like Supplemental Security Income (SSI).
What Extra Help actually pays for
Extra Help covers your Part D plan premium — the monthly cost of your drug plan. It also covers your annual deductible, which is the amount you have to pay out of pocket before your plan starts paying for drugs. Most importantly, it reduces your copayments (the fixed amount you pay per prescription) or coinsurance (a percentage of the drug cost).
The exact amount Extra Help pays depends on your income. People with the lowest incomes pay nothing for premiums, deductibles, or copayments — Extra Help covers it all. People with higher incomes within the range pay a small share themselves. Social Security will tell you your specific cost-sharing amounts when you are approved.
Extra Help does not cover drugs that your Part D plan does not cover, and it does not change which drugs your plan covers. It only reduces what you pay for the drugs your plan includes. If your plan does not cover a drug you need, you would have to switch plans during the annual enrollment period or pay the full cost yourself.
How to request Extra Help from Social Security
You can request Extra Help in three ways: online, by phone, or in person. The online method is the fastest. Go to ssa.gov/benefits/medicare/forms.html and look for the form titled "process for Help with Medicare Prescription Drug Plan Costs" (Form SSA-1020). You can fill it out and submit it online, and Social Security will contact you if they need more information.
If you prefer to call, dial 1-800-772-1213 (TTY 1-800-325-0778 for deaf and hard of hearing callers). Social Security representatives can answer questions and take your request over the phone. Wait times are usually shorter early in the morning or on weekdays.
You can also visit your local Social Security office in person. Find the nearest office at ssa.gov/locator. Bring your Social Security card, proof of citizenship or legal residency, and recent pay stubs or tax returns to show your income. Bring bank statements or other proof of your resources as well.
What happens after you request Extra Help
Social Security typically processes Extra Help requests within two to four weeks. They will contact you by mail or phone if they need more information — for example, if your income documentation is unclear or if they need to verify your resources. Respond promptly, because delays in providing information can slow approval.
Once you are approved, Social Security sends your approval notice to you and to CMS. Your Part D plan is notified, and your Extra Help coverage begins the first day of the month after Social Security approves your request. You do not have to do anything with your plan; the coverage is automatic once the plan receives notification.
Your Extra Help status is good for one year. Social Security will send you a notice before it expires, usually a few months in advance. You can request to renew it, and if your income and resources have not changed significantly, renewal is usually straightforward.
What to do if your income or resources change
If your income or resources increase after you are approved for Extra Help, you should report the change to Social Security. You do not lose Extra Help when ready, but Social Security needs to know so they can recalculate your cost-sharing amounts or determine whether you still meet the income limit.
If your income drops — for example, because you retired or lost a job — report that too. A lower income might mean Extra Help covers more of your costs. You can report changes by calling 1-800-772-1213, visiting your local Social Security office, or logging into your Social Security account at ssa.gov.
If you lose Extra Help because your income or resources went over the limit, you can request it again if your situation changes. There is no penalty for losing and regaining Extra Help.
Extra Help and your Part D plan choices
Extra Help works with any Medicare Part D prescription drug plan. You choose the plan during the annual enrollment period (October 15 to December 7 each year), and Extra Help applies to whichever plan you pick. If you switch plans, your Extra Help coverage moves with you to the new plan.
When you are choosing a Part D plan, remember that Extra Help reduces your costs but does not eliminate the difference between plans. Some plans have lower premiums but higher copayments; others have higher premiums but lower copayments. Use the Medicare Plan Finder tool at medicare.gov to compare plans and see your estimated costs after Extra Help is applied.
If you are already enrolled in a Part D plan when you are approved for Extra Help, your coverage starts automatically with your current plan. You do not have to switch plans unless you want to.
Frequently Asked Questions
Can I get Extra Help if I am already on Medicaid?
Yes. Some people are enrolled in both Medicaid and Extra Help. If you are on Medicaid, Social Security will still process your Extra Help request. In some cases, Medicaid and Extra Help coordinate to cover your drug costs. Contact your state Medicaid office or Social Security to understand how both programs work together in your situation.
What if I miss the important date to request Extra Help?
There is no annual important date for Extra Help like there is for Part D enrollment. You can request it any time during the year. However, your coverage does not start until the month after Social Security approves your request, so explore sooner means you start saving on drug costs sooner.
Do I have to be a U.S. citizen to get Extra Help?
No. You must be a lawful permanent resident or have a valid visa, but you do not have to be a citizen. You will need to provide proof of your legal residency status when you request Extra Help. Bring your green card, visa, or other immigration documents to Social Security.
What if my Part D plan is not available in my state anymore?
If your plan stops being offered, Medicare will automatically move you to another plan in your area, and your Extra Help will move with you. You will receive a notice from Medicare explaining the change. You can choose a different plan during the annual enrollment period if you prefer.
Can I use Extra Help with a Medicare Advantage plan that includes drug coverage?
No. Extra Help only works with standalone Part D prescription drug plans. If you have a Medicare Advantage plan with drug coverage (Part C), you cannot use Extra Help. However, you can switch to Original Medicare and a Part D plan during the annual enrollment period to become may be able to access for Extra Help.