What Extra Help Covers and Who It's For

Extra Help is a federal program that pays part of your Medicare prescription drug costs if your income and savings are below certain limits. It covers the monthly premiums for Part D plans, 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 pick any Part D plan available in your area, and Extra Help works with whichever one you choose.

The program exists because Part D premiums and out-of-pocket costs can be steep for people on fixed incomes. If you receive Supplemental Security Income (SSI) or are a Medicare Savings Program participant, you may already be enrolled automatically. Otherwise, you can request it through Social Security.

Key Takeaways

  • Extra Help pays your Part D premium, deductible, and a portion of your pharmacy costs if your monthly income is below roughly $1,550 for an individual or $2,100 for a couple (amounts vary yearly).
  • You do not need to be on Medicaid or any other program to use Extra Help — it works alongside any Part D plan you choose.
  • If you already receive SSI or are in a Medicare Savings Program, Social Security may have enrolled you automatically, so check your mail.
  • You can request Extra Help through Social Security by phone, mail, or online, and the decision usually comes within two weeks.
  • Your coverage level depends on your exact income and savings, so what you pay out of pocket varies — the program has three tiers of help.

Income and Savings Limits

Extra Help has income and asset thresholds that change each year. For 2024, the monthly income limit is roughly $1,550 for a single person and $2,100 for a married couple living together. Your "income" includes Social Security, pensions, wages, and interest — but not Supplemental Security Income itself. The asset limit is roughly $8,100 for an individual and $12,150 for a couple, counting savings, stocks, and bonds but not your home or car.

These numbers shift annually, so if you were turned down in a previous year, your situation may have changed. Social Security uses the current year's limits when they review your request. If you are close to the limit, it is worth asking — the difference between being $50 over and $50 under can mean thousands of dollars in drug coverage over a year.

The Three Levels of Help

Extra Help does not give everyone the same amount of coverage. The program has three tiers based on your exact income and savings. People with the lowest income pay nothing for their Part D premium and a small copay at the pharmacy — usually $1 to $3 per prescription. People in the middle tier pay a small premium and a slightly higher copay. People closer to the income limit pay more of the premium but still get help with out-of-pocket costs.

Social Security will tell you which tier you fall into when they notify you of approval. Your copay amounts depend on which Part D plan you choose, because different plans have different pharmacy networks and cost structures. Even within the same tier, your actual out-of-pocket cost can vary by $10 or $20 per prescription depending on the plan — so comparing plans before you enroll still matters.

How to Request Extra Help

You can request Extra Help through Social Security in three ways: online at ssa.gov, by phone at 1-800-772-1213, or by visiting your local Social Security office in person. Online is usually fastest if you have a Social Security account set up. By phone, expect to wait on hold, but a representative can walk you through the questions and submit your request the same day.

When you request it, have ready your most recent tax return or pay stubs, a list of your current medications and their costs, and information about your savings and investments. Social Security will ask about your income, assets, and household size. The decision usually comes within two weeks, though it can take longer if they need to verify information with the IRS or another agency. You will receive a letter in the mail telling you whether you were approved and what tier of help you received.

What Happens After You Are Approved

Once you are approved, Social Security sends you a notice with your approval date and your help tier. You can then enroll in any Part D plan you want — the Extra Help works automatically when you pick a plan and the pharmacy processes your prescription. You do not have to tell the plan you have Extra Help; Social Security and Medicare communicate directly.

Your approval lasts for one year. Social Security will send you a renewal notice before it expires, usually a few months ahead of time. If your income or savings change during the year, you can request a review at any time — you do not have to wait for the annual renewal. If you move, change your phone number, or want to update your address, contact Social Security so they can reach you when it is time to renew.

What Extra Help Does Not Cover

Extra Help covers Part D prescription drugs, but it does not cover other Medicare costs like your Part B premium, hospital stays, or doctor visits. It also does not cover drugs that Medicare Part D excludes — such as certain over-the-counter medications, drugs used to treat erectile dysfunction, or cosmetic treatments. If your Part D plan does not cover a particular drug, Extra Help cannot make it covered.

Some people may have access to for both Extra Help and a Medicare Savings Program, which pays your Part B and Part D premiums. If you think you might be may be able to access for both, ask Social Security — they can review you for the Medicare Savings Program at the same time they process your Extra Help request.

When to Contact Social Security About Your Coverage

Contact Social Security if your income drops significantly, you lose a source of income, your savings change, or you move to a different state. You should also reach out if you are not receiving the help level you expected when you fill a prescription, or if you were approved but never received your approval letter. If you have questions about whether a specific drug is covered under your plan, call your Part D plan directly — they have the most current formulary information.

If you are already on a Part D plan and later become may be able to access for Extra Help, you can switch plans during the Extra Help enrollment period, which runs from January 1 to February 15 each year. This matters because some plans are designed to work better with Extra Help and have lower copays for people in your tier.

Frequently Asked Questions

Do I lose Extra Help if I go back to work?

Not automatically. Your income limit is based on your total monthly income, so if you earn wages that push you over the limit, you would lose Extra Help. But if your wages are modest and your total income stays below the limit, you keep it. Social Security counts all income sources together, so let them know if your situation changes.

Can I use Extra Help with any Part D plan?

Yes. Extra Help works with any Part D plan available where you live. However, some plans have lower copays for Extra Help members than others, so comparing plans before you enroll can save you money. Your local State Health Insurance information Program (SHIP) can help you compare plans for free.

What if I was denied Extra Help?

You can request reconsideration if you believe Social Security made a mistake about your income or assets. You have 60 days from the denial letter to ask for a review. If your financial situation has changed since you applied, you can also submit a new request — Social Security will use the current information.

Does Extra Help count as income for other programs?

No. Extra Help itself is not counted as income when you explore for Medicaid, SSI, or other need-based programs. However, the money you save by using Extra Help does not change your actual income or assets, so it does not affect your may be able to access for other programs.

Can I switch Part D plans if I have Extra Help?

Yes, during the annual enrollment period from October 15 to December 7, or during the Extra Help enrollment period from January 1 to February 15. You can also switch if you move to a new state or if your plan leaves Medicare. Your Extra Help approval stays the same — you just enroll in a different plan.