What Extra Help Covers and Who It's For

Extra Help is a federal program that pays some or all of your Medicare Part B premiums if your income and savings fall below certain limits. It does not cover your deductible or coinsurance — only the monthly premium you owe to Medicare. The program is run by Social Security, and the income and asset limits change each year.

You may be able to get Extra Help if you are already on Medicare and your household income is below 150% of the federal poverty line. For 2024, that means a single person earning less than about $1,968 per month, or a married couple earning less than about $2,656 per month combined. Your total savings and investments must also be below $8,100 for a single person or $12,150 for a married couple. These dollar amounts are updated yearly.

You do not need to be a U.S. citizen to get Extra Help, but you must be a lawful permanent resident or have been granted asylum. You must also be a resident of one of the 50 states, Washington D.C., or the U.S. territories.

Key Takeaways

  • Extra Help pays your Medicare Part B premium if your monthly income is below 150% of the federal poverty line and your savings are under the yearly limit.
  • 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.
  • Social Security will tell you within 30 days whether you are approved, and the benefit usually starts the month after you are approved.
  • If your income or savings change during the year, you should report the change to Social Security so your benefit stays correct.
  • You can also ask a local Area Agency on Aging or a SHIP counselor (State Health Insurance information Program) to help you understand whether you may be may be able to access.

Income and Savings Limits That Determine Your Benefit

Social Security uses your household income to decide whether you get Extra Help and how much of your premium they will pay. Household income includes wages, Social Security benefits, pensions, interest, dividends, and rental income. It does not include Supplemental Security Income (SSI) or certain other benefits.

Your countable resources — savings, stocks, bonds, and property you own besides your home — must be under the yearly limit. Your home, car, and personal belongings do not count. If you are married, Social Security counts both spouses' income and resources together, even if only one of you is on Medicare.

The income and resource limits are set by federal law and increase each January. You can find the current year's limits on the Social Security website or by calling 1-800-772-1213. If you are close to the limit, it is worth asking — Social Security sometimes counts income differently than you might expect, and certain types of income may not count at all.

how the process works for Extra Help

You can explore for Extra Help 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.

When you explore, have these documents ready or nearby: your most recent tax return or pay stubs, bank statements showing your savings and investments, and proof of citizenship or lawful permanent resident status. If you are married, you will also need your spouse's Social Security number and income information. You do not have to mail anything in — Social Security can verify most information electronically.

Social Security will send you a letter within 30 days telling you whether you are approved. If you are approved, your Extra Help usually starts the month after the approval letter is dated. Your Part B premium will be reduced or eliminated, depending on your income level. If you are denied, the letter will explain why and tell you how to appeal.

What Happens If Your Income or Savings Change

If your income or savings change during the year — for example, you get a raise, lose a job, or receive an inheritance — you should report the change to Social Security. You can report changes online, by phone, or in person using the same contact methods as the original process. Social Security will recalculate your benefit and let you know if the amount changes.

If your income goes above the limit, your Extra Help will end. Social Security will tell you the exact month this happens so you know when you will start paying your full Part B premium again. If your income drops back below the limit later, you can explore again.

Even if you do not report a change, Social Security may find out through tax records or other sources. If you received Extra Help you were not may have access to to, you may have to repay some of it. Reporting changes promptly keeps your benefit accurate and avoids problems later.

Getting Help With Your process

If you are not comfortable explore online or by phone, you can visit your local Social Security office in person. Staff there can walk you through the process and answer questions about what documents you need. You can find your nearest office at ssa.gov or by calling 1-800-772-1213.

You can also contact your local Area Agency on Aging, which has counselors trained to help seniors understand Medicare programs. Many Area Agencies on Aging offer free help with Extra Help applications. To find yours, call the Eldercare Locator at 1-800-677-1116 or visit eldercare.acl.gov.

State Health Insurance information Program (SHIP) counselors are another free resource. SHIP is a national program with counselors in every state who can explain Extra Help, help you gather documents, and answer questions about your Medicare coverage. You can find your state's SHIP by visiting shiptalk.org or calling 1-877-839-2675.

How Extra Help Affects Your Other Benefits

Getting Extra Help does not affect your Social Security benefits, Medicare coverage, or other programs you may be on. It is a separate benefit that only pays your Part B premium. If you are on Medicaid or Supplemental Security Income (SSI), you may be able to get Extra Help at the same time.

If you also get help paying for prescriptions through the Low-Income Subsidy (LIS) program for Part D, Social Security will coordinate both benefits. You do not explore separately for LIS — if you are approved for Extra Help, Social Security will automatically check whether you also may have access to for prescription help.

What to Ask Your Doctor or Social Security

Before you explore, ask yourself: Do I know my total household income for the past year? Do I know how much money I have in savings and investments? Have there been any major changes to my income or savings in the past few months?

When you contact Social Security, ask: What is the current income limit for my household size? What counts as income for this program? What documents do I need to bring or send? How long will it take to hear back about my process? If I am denied, can I appeal?

If you work with a SHIP counselor or Area Agency on Aging, ask them: Based on my income and savings, do you think I might be may be able to access? What documents should I gather before I explore? If my situation changes, how do I report it to Social Security?

Frequently Asked Questions

Does Extra Help pay for my Part B deductible or coinsurance?

No. Extra Help only pays your monthly Part B premium. You are still responsible for your deductible (the amount you pay before Medicare starts paying) and coinsurance (your share of the cost after you meet the deductible). Some states have programs that help with these costs — ask your SHIP counselor.

If I am denied, can I appeal?

Yes. Your denial letter will explain how to appeal and the important date to do so. You have the right to request a reconsideration, and if you disagree with that decision, you can request a hearing before an administrative law judge. SHIP counselors can help you understand the appeal process.

What if I work part-time and my income varies month to month?

Social Security looks at your income over a 12-month period, not just one month. If your income varies, bring recent pay stubs or tax returns showing your average earnings. Social Security will use that to decide whether you are below the limit.

Can I get Extra Help if I am not yet on Medicare?

No. You must already be enrolled in Medicare Part B to get Extra Help. If you are not yet on Medicare, you can learn about when to enroll by contacting Medicare at 1-800-633-4227 or visiting medicare.gov.

If I move to a different state, does my Extra Help continue?

Yes. Extra Help is a federal program, so it works the same way in every state. If you move, tell Social Security your new address so they can send you notices and updates. Your benefit will not change just because you moved.