The Basic Income and Resource Limits

Medicare Extra Help is a federal program that pays part or all of your Medicare prescription drug plan premiums and out-of-pocket costs. To be considered, your income and resources must fall below certain thresholds set each year. For 2024, your monthly income must be at or below 150% of the federal poverty level — that is roughly $2,175 per month for a single person or $2,925 for a married couple living together. These numbers change annually, so you will need to check the current year's limits when you look into the program.

Your countable resources — savings, stocks, bonds, and similar assets — must also stay below a limit. For 2024, that limit is $8,100 for a single person or $12,150 for a married couple. Your home, one vehicle, and certain retirement accounts do not count toward this total. If you are close to these limits but not quite under them, you may still be worth investigating further, because some income sources (like Supplemental Security Income) are not counted at all.

Key Takeaways

  • Your monthly income must be at or below 150% of the federal poverty level, which is roughly $2,175 for a single person in 2024.
  • Your countable resources (savings and investments) must be below $8,100 for a single person or $12,150 for a married couple.
  • You must be enrolled in Medicare Part B and have a Medicare prescription drug plan, or be willing to join one.
  • You can check your status and submit information through Social Security, your state Medicaid office, or online at the Social Security website.
  • If your income or resources change during the year, you can report the change and your benefit amount may adjust.

Medicare Enrollment Requirements

You cannot receive Extra Help unless you are already enrolled in Medicare Part B (the part that covers doctor visits and outpatient care). You also must be enrolled in a Medicare prescription drug plan — either a standalone Part D plan or a Medicare Advantage plan that includes drug coverage. If you are not yet in a drug plan, you will need to join one before Extra Help can begin paying your costs.

If you are already in a drug plan and your income drops or you experience a life change (like the death of a spouse or loss of income), you can report this to Social Security at any time during the year. Your Extra Help benefit will then be recalculated based on your new situation. You do not have to wait for the annual enrollment period to make this change.

Who Automatically Receives Extra Help

If you receive Supplemental Security Income (SSI) or certain state information programs, you are automatically enrolled in Extra Help without having to submit any paperwork. Social Security will notify you by mail that you have been approved. You will receive the maximum benefit level, meaning the program covers your full drug plan premium and your out-of-pocket costs are reduced to the lowest possible amounts.

If you are automatically enrolled but believe the decision is wrong — for example, if your income has risen since you started receiving SSI — you can contact Social Security to report the change. Automatic enrollment does not lock you in permanently; your status can be reviewed if your circumstances change.

How to Report Your Income and Resources

If you do not receive SSI or state information, you will need to report your income and resources yourself. You can do this through three main routes: by phone with Social Security at 1-800-772-1213, by visiting your local Social Security office in person, or by submitting a form online through the Social Security website. The form you need is called the process for Help with Medicare Prescription Drug Plan Costs.

When you contact Social Security, have ready your most recent tax return or a list of your income sources for the past month, your bank statements showing your savings and investments, and your Medicare card. If you are married and your spouse's income or resources are part of your household, you will need their information as well. Social Security will tell you on the spot whether you appear to meet the income and resource limits, though the formal decision typically comes by mail within two to four weeks.

What Happens If Your Income Changes

If your income rises above the limit after you have been approved, your Extra Help will end. Social Security will send you a notice explaining when the benefit stops. If your income drops back below the limit later in the year, you can report the change and be reinstated. Many people's income fluctuates — for example, if you work part-time or receive seasonal income — so it is worth reporting changes as they happen rather than waiting for the annual review.

If you receive a one-time payment like an inheritance, a tax refund, or a settlement, this may temporarily push your resources above the limit but does not usually affect your income-based approval. However, if the payment is large enough to keep your resources over the limit for the entire year, your benefit may be suspended. Contact Social Security to discuss how a specific payment will affect your status.

State Medicaid Programs and Extra Help

Some states run their own programs that help people pay for Medicare costs, and these programs sometimes have different income or resource limits than federal Extra Help. If you live in a state with a Medicare Savings Program or similar state information, you may be able to receive help even if you do not quite meet the federal Extra Help thresholds. Your state Medicaid office can tell you whether you meet their specific requirements.

You can find your state Medicaid office through the Centers for Medicare & Medicaid Services website or by calling 1-800-MEDICARE. Some states process Extra Help applications themselves rather than through Social Security, so it is worth asking which agency handles the program in your state. If you are turned down for federal Extra Help, ask whether your state has its own program you might be able to use instead.

Common Reasons Applications Are Denied

The most common reason an process is denied is that income or resources are above the limit. The second most common is that the person is not yet enrolled in Medicare Part B or a drug plan. If your process is denied, Social Security will send you a letter explaining why. The letter will also tell you how to appeal the decision if you believe the information was wrong or incomplete.

If you were denied because of income or resources, ask Social Security whether you might be may be able to access for a state program instead. If you were denied because you are not in a drug plan, you can join one during the annual enrollment period (October 15 to December 7 each year) or during a special enrollment period if you have had a may have access to life event. Once you are in a plan, you can resubmit your Extra Help information.

Frequently Asked Questions

Does my spouse's income count if we are married but file separate tax returns?

Yes. For Extra Help purposes, Social Security counts the income and resources of both spouses if you are married and living together, regardless of how you file taxes. If you are separated or divorced, only your own income and resources count. If your spouse has high income but you have little, you may still be denied because the household income is too high.

What if I live with my adult child or grandchild — does their income count?

No. Only your income and your spouse's income (if married) count toward the limit. Your adult children, grandchildren, or other household members do not affect your may be able to access, even if they contribute to household expenses or you share a home.

Can I be approved for Extra Help if I am not yet on Medicare?

No. You must be enrolled in Medicare Part B before you can receive Extra Help. If you are not yet 65 or do not yet have Medicare, you can still submit an process, but it will not be processed until you enroll in Part B. Once you join Medicare, contact Social Security again to set up your Extra Help.

If I am approved, how long does the benefit last?

Extra Help is approved for one year at a time. Social Security will review your income and resources each year and send you a renewal notice. If nothing has changed, your benefit will continue. If your situation has changed, you may need to report it so your benefit can be adjusted or renewed.

What if I think Social Security made a mistake on my process?

You have the right to appeal any decision. The denial or approval letter will explain how to request an appeal and the important date for doing so. You can appeal by phone, by mail, or in person at your local Social Security office. Bring any documents that support your case — recent pay stubs, bank statements, or proof of income sources.