What Extra Help With Medicare Covers

Extra Help is a federal program that pays part or all of your Medicare prescription drug costs if your income and savings are 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 special plan to use it — you enroll in any standard Part D prescription drug plan, and Extra Help reduces what you owe.

The program is run by Social Security and the Centers for Medicare & Medicaid Services (CMS). It has been available since 2008 and is sometimes called the Low-Income Subsidy or LIS. Unlike some information programs, Extra Help is permanent once you are approved — you do not have to reapply each year unless your income or household size changes.

Key Takeaways

  • Extra Help pays your Part D premium, deductible, and copayments if your income is below roughly $21,000 per year for a single person or $43,000 for a married couple (amounts vary by year and state).
  • 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 already on Medicaid or Supplemental Security Income (SSI), you are automatically enrolled in Extra Help without having to explore.
  • Social Security will tell you within two weeks whether you are approved, and coverage starts the first of the month after approval.
  • You must be enrolled in Medicare Part A or Part B to use Extra Help, and you must pick a Part D plan to get the benefit.

Income and Savings Limits for Extra Help

Extra Help has income and savings thresholds that change each year. For 2024, the income limit is roughly $21,690 for a single person and $43,380 for a married couple living together. Your income includes Social Security, pensions, wages, and interest — but not Supplemental Security Income (SSI) payments. If you are married, both spouses' income counts even if only one of you is on Medicare.

The program also looks at your savings and other resources. For 2024, you can have up to about $8,550 in savings as a single person or $12,800 as a married couple. This includes bank accounts, stocks, and bonds, but not your home, car, or life insurance. If your income or savings is slightly above the limit, you may still may have access to for a reduced benefit that lowers your costs.

These dollar amounts increase slightly each year. You can find the current limits on the Social Security website or by calling 1-800-772-1213. The limits also vary slightly by state, so it is worth checking your specific state's threshold.

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, or in person at your local Social Security office. The online process takes about 15 minutes and you can save your work and come back to it. You will need your Social Security number, date of birth, and information about your income and savings.

Social Security will ask about your household size, monthly income from all sources, and the value of your bank accounts and other resources. Have recent pay stubs, tax returns, or benefit statements handy when you explore. If you do not have exact figures, estimates are fine — Social Security can verify them later.

Social Security typically tells you whether you are approved within two weeks. If you are approved, your coverage starts on the first of the month after the approval date. You will receive a notice in the mail with your approval status and the amount you will pay for premiums and copayments under Extra Help.

Automatic Enrollment if You Receive SSI or Medicaid

If you already receive Supplemental Security Income (SSI) or Medicaid, you do not need to explore for Extra Help — you are enrolled automatically. Social Security will send you a notice telling you that you have Extra Help and what your costs will be. This automatic enrollment happens as soon as you turn 65 and enroll in Medicare Part B, or if you become may be able to access for SSI or Medicaid while already on Medicare.

Even if you are automatically enrolled, you still must choose a Part D prescription drug plan. Social Security will send you information about plans available in your area. If you do not pick a plan by the important date, Medicare will assign you to one automatically, though it may not be the best choice for your medications. It is worth spending time choosing a plan that covers the drugs you take.

What You Pay Under Extra Help

Your out-of-pocket costs under Extra Help depend on your income level. If your income is below 135% of the federal poverty line (roughly $18,000 for a single person in 2024), you pay nothing for premiums, deductibles, or copayments — the program covers it all. If your income is between 135% and 150% of poverty, you pay small copayments but no premium or deductible.

If your income is above 150% of poverty but still below the income limit, you pay a share of the premium and copayments. The exact amount depends on your income and which Part D plan you choose. Social Security will tell you your specific costs when you are approved. These costs are much lower than what you would pay without Extra Help, but they are not zero.

Your copayments under Extra Help are capped — you will not pay more than a certain amount per prescription, even for expensive drugs. This cap also changes each year and is set by CMS. Once you hit the cap, the plan covers the rest of your drug costs for that year.

Keeping Your Extra Help Active

Once you are approved for Extra Help, you do not have to reapply every year. However, Social Security will check your income and savings periodically. If your situation changes — you get a raise, inherit money, or your household size changes — you must report it to Social Security. You can report changes online, by phone, or in person.

If your income or savings goes above the limit, you will lose Extra Help. Social Security will send you a notice before this happens, usually giving you time to appeal if you think the decision is wrong. If you move to a different state, your Extra Help continues, but you may need to pick a new Part D plan because plans vary by state.

You must stay enrolled in a Part D plan to keep Extra Help. If you drop your Part D coverage, you lose the benefit. If you switch to a different Part D plan during the annual enrollment period (October 15 to December 7), your Extra Help automatically moves to the new plan.

What to Ask Your Doctor and When to Seek Help

Once you have Extra Help, talk to your doctor about your copayment amounts. Some medications may have high copayments under your plan, and your doctor might be able to prescribe a similar drug with a lower copayment. Ask your pharmacist to show you the copayment for each drug before you fill it — prices can vary between pharmacies, and some offer discounts for certain medications.

If you think Social Security made a mistake about your approval or your costs, you can ask for a reconsideration. Call 1-800-772-1213 and ask to speak with someone about your Extra Help case. You have 60 days from the date of the notice to request a reconsideration. Bring any documents that show your actual income or savings if the decision was based on incorrect information.

If you have questions about which Part D plan to choose or how Extra Help works with your specific medications, call Medicare at 1-800-MEDICARE (1-800-633-4227). They can compare plans for you and explain what you will pay for your drugs under each option. This service is free and available 24 hours a day.

Frequently Asked Questions

Do I have to pick a specific Part D plan to get Extra Help?

No. Extra Help works with any standard Part D plan. You can choose whichever plan covers your medications at the lowest cost. Social Security does not require you to pick a particular plan, and you can change plans each year during the annual enrollment period without losing Extra Help.

What happens to my Extra Help if I move to a different state?

Your Extra Help continues, but Part D plans vary by state. You will need to pick a new plan that is available in your new state. Contact Medicare at 1-800-MEDICARE to find plans in your new location. Your Extra Help benefit amount stays the same based on your income, but the specific plans and copayments will be different.

Can I get Extra Help if I am still working?

Yes, if your total income (including wages) is below the limit. Social Security counts all income sources — wages, self-employment, pensions, Social Security, interest, and rental income. If you are working part-time and your total income is below the threshold, you can still may have access to for Extra Help.

What if my income goes up after I am approved?

You must report the income change to Social Security. If your new income stays below the limit, you keep Extra Help. If it goes above the limit, you will lose the benefit. Social Security will send you a notice before this happens and explain your options, including whether you can appeal the decision.

Do I lose Extra Help if I go into a nursing home or hospital?

No. Extra Help continues even if you are in a hospital or nursing home. Your income and savings limits may change slightly if you are in a long-term care facility, so contact Social Security to update your information. Your Part D plan and copayments stay the same unless you choose to switch plans during the annual enrollment period.