What Medicare Extra Help Covers
Medicare Extra Help is a federal program that pays part or all of your prescription drug costs if your income and resources fall below certain limits. It reduces what you pay for medications covered under Medicare Part D plans. The program covers the same drugs as Part D, but with lower out-of-pocket costs — you may pay nothing for some drugs, a small copay for others, and a reduced percentage for the rest.
Extra Help does not cover all medications. Your Part D plan determines which drugs are covered, and Extra Help then reduces your share of the cost. If a drug is not on your plan's formulary (the list of covered drugs), Extra Help will not pay for it, though you can ask your plan to make an exception.
Key Takeaways
- Extra Help reduces prescription drug costs for people with limited income and resources, covering copays and coinsurance on Part D drugs.
- Income limits vary by household size and change each year; in 2024, a single person earning under roughly $21,000 per year may be may be able to access, though this amount varies by state.
- You must be enrolled in a Medicare Part D plan to use Extra Help; the program works by reducing your costs under that plan.
- Social Security, the Railroad Retirement Board, or your state Medicaid office can process your request, and you can also contact Medicare directly at 1-800-MEDICARE.
- If you receive Supplemental Security Income (SSI) or Medicaid, you are automatically enrolled in Extra Help without having to request it.
Income and Resource Limits for Extra Help
Extra Help has income and resource limits that change each year. The income limit is usually set at 150% of the federal poverty level. For 2024, this means a single person with income under approximately $21,000 per year and a married couple with income under approximately $28,000 per year may be may be able to access, though these figures vary slightly by state and are adjusted annually.
Resources — savings, investments, and property you own — also matter. For 2024, you can have up to roughly $15,000 in countable resources as a single person or $30,000 as a married couple. Your home and one vehicle do not count toward this limit. If your income or resources are slightly above these thresholds, you may still receive partial help.
Because limits change yearly, contact Social Security or Medicare to learn the current thresholds for your state. You can call Social Security at 1-800-772-1213 or Medicare at 1-800-MEDICARE to ask about current limits.
How to Request Extra Help
You have three main routes to request Extra Help. The fastest is usually to contact Social Security directly. Call 1-800-772-1213 (TTY 1-800-325-0778) and ask to request Extra Help. Social Security will ask about your income and resources, and you can complete the request over the phone. You can also visit your local Social Security office in person or submit a paper form.
If you prefer to work through your state, contact your state Medicaid office. Many states process Extra Help requests alongside other benefit programs. Your state Medicaid office can tell you whether they handle Extra Help in your state and what documents they need.
You can also contact Medicare at 1-800-MEDICARE (1-800-633-4227) and ask them to forward your request to the appropriate agency. Medicare can also mail you a paper form to complete and return. Have your Social Security number, birth date, and information about your income and resources ready when you call.
What Documents You May Need
When you request Extra Help, have documents ready that show your income and resources. For income, you may need recent pay stubs, tax returns, or a letter from Social Security showing your benefit amount. If you are self-employed, bring tax returns or profit-and-loss statements.
For resources, be ready to describe bank accounts, savings, stocks, bonds, and other investments. You do not usually need to bring bank statements unless the agency asks, but having them available speeds up the process. If you own property other than your home, have the deed or property tax statement ready.
If you receive SSI or Medicaid, you may not need to provide additional documents — Social Security and state agencies often share information, and you may be enrolled automatically.
Automatic Enrollment If You Receive SSI or Medicaid
If you receive Supplemental Security Income (SSI) or your state's Medicaid program, you are automatically enrolled in Extra Help. You do not have to request it. Social Security and state Medicaid agencies share information, and your enrollment happens without action on your part.
You will receive a notice in the mail confirming your Extra Help enrollment. If you do not receive a notice within a few weeks of becoming may be able to access for SSI or Medicaid, contact Social Security or your state Medicaid office to confirm enrollment.
How Extra Help Reduces Your Drug Costs
Extra Help works by reducing the out-of-pocket costs you pay under your Part D plan. Instead of paying the full copay or coinsurance, you pay a reduced amount. For generic drugs, you may pay $0 to $4 per prescription. For brand-name drugs, you may pay $0 to $10 per prescription. The exact amounts depend on your plan and the drug.
You still choose a Part D plan, and Extra Help reduces your costs under that plan. If your plan's copay for a generic drug is $10, Extra Help may reduce it to $3. If the copay is already $3, Extra Help may cover it entirely. The program also reduces or eliminates the coverage gap (the "donut hole") that Part D beneficiaries without Extra Help face.
Your costs are capped: in 2024, your out-of-pocket spending is limited to roughly $6,700 per year for covered drugs, after which Medicare covers the full cost for the rest of the year. With Extra Help, your actual spending is usually much lower.
Renewing Your Extra Help Each Year
Extra Help is not permanent. You must renew it each year, usually around the same time you renew your Part D plan. Social Security will send you a renewal notice in the mail. You can renew by phone, mail, or in person at your local Social Security office.
If your income or resources change during the year, report the change to Social Security. If your income increases above the limit, you may lose Extra Help. If it decreases, you may become may be able to access for more help. Social Security can adjust your benefit mid-year if circumstances change significantly.
Mark your calendar for renewal time each year. If you miss the important date, you may lose Extra Help temporarily, though you can request it again and coverage may be restored retroactively.
Frequently Asked Questions
Do I have to be on Medicare Part D to use Extra Help?
Yes. Extra Help reduces your costs under a Part D plan, so you must be enrolled in Part D to receive Extra Help. If you are not yet on Part D, you can enroll in a plan and request Extra Help at the same time. Social Security can help you with both.
What happens if I earn a little more than the income limit?
You may still receive partial Extra Help. The program has a sliding scale: as your income rises above the limit, your share of costs increases gradually rather than cutting off completely. Contact Social Security to learn whether you may have access to for partial help.
Can I switch Part D plans if I have Extra Help?
Yes. You can change plans during the annual enrollment period (October 15 to December 7) or if you have a may have access to life event. Extra Help follows you to your new plan. Tell your new plan that you have Extra Help so they explore the reduced costs from the start.
What if my state does not have a Medicaid program?
Every state has a Medicaid program, though they vary in who they cover. If you cannot reach your state Medicaid office, contact Social Security instead — they can process your Extra Help request directly.
Does Extra Help cover over-the-counter drugs?
No. Extra Help covers only prescription drugs covered by your Part D plan. Over-the-counter medications are not included, though some Part D plans offer limited coverage for certain over-the-counter items as part of their plan benefits.