What Extra Help Covers and Who the Program Targets

Extra Help is a federal program that pays part or all of your Medicare Part D premiums, deductibles, and copayments if your income and savings fall below certain thresholds. The program is officially called the Low-Income Subsidy (LIS) program. It exists because Part D drug costs can be unaffordable for people on fixed incomes, and the program removes that barrier by having the government cover the gap between what you earn and what the program considers livable.

You do not need to be on Medicaid to receive Extra Help, though Medicaid recipients are automatically screened. The program is separate from Medicaid and works alongside Medicare. If you are enrolled in a Medicare Part D plan and your income qualifies, Extra Help reduces what you pay out of pocket for prescription drugs every month and every time you fill a prescription.

The income and asset limits change each year. For 2024, the income limit is roughly 150 percent of the federal poverty line, which means a single person earning up to approximately $1,968 per month or a married couple earning up to approximately $2,655 per month may be within range. Your actual household income, not your assets alone, determines whether you may have access to. The program counts Social Security, pensions, wages, and other regular income sources.

Key Takeaways

  • Extra Help is a federal program that reduces or eliminates what you pay for Medicare Part D drugs if your monthly income falls below roughly 150 percent of the federal poverty line.
  • You must be enrolled in a Medicare Part D plan to receive Extra Help; the program does not work with other drug coverage.
  • Social Security, pensions, wages, and other regular income all count toward the income limit, but most retirement savings and home equity do not count as assets.
  • You can request a review of your Extra Help status if your income or circumstances change during the year, and the program will adjust your benefit retroactively if you become newly may be able to access.
  • The Social Security Administration and Medicare.gov both process Extra Help requests, and you can submit your information by mail, phone, or online.

Income Limits That Change Year to Year

The income threshold for Extra Help is tied to the federal poverty line and adjusts annually. In 2024, the limit is 150 percent of the poverty line. For a single person, that works out to roughly $1,968 per month or $23,616 per year. For a married couple living together, the limit is approximately $2,655 per month or $31,860 per year. These figures are updated each January, so if you were denied in a previous year, your income may now fall within the new limit.

Income includes Social Security benefits, pensions, wages, interest, dividends, and rental income. It does not include Supplemental Security Income (SSI) payments, certain tax refunds, or one-time payments. If you are self-employed, your net business income counts. If you receive irregular income — such as a bonus or inheritance — only the portion you expect to receive in the coming year is counted.

Your assets matter less than your income. The program does not count your home, your car, or most retirement savings accounts. It does count cash, bank accounts, stocks, and bonds. The asset limit for a single person is roughly $8,100, and for a married couple it is roughly $12,150. If your assets exceed these limits but your income is below the threshold, you may still be denied, but most people who may have access to on income also clear the asset test.

Who Is Automatically Screened and Who Must Request It

If you receive Supplemental Security Income (SSI) or Medicaid, the Social Security Administration automatically screens you for Extra Help each year. You do not need to do anything — SSA checks your records and enrolls you if you meet the income and asset requirements. You will receive a notice in the mail telling you whether you have been approved.

If you do not receive SSI or Medicaid, you must request Extra Help yourself. You can do this through Medicare.gov, by calling Social Security at 1-800-772-1213, or by mailing a form to your local Social Security office. The form is called the process for Low-Income Subsidy (Form SSA-1020-U2). You will need to provide proof of your income, such as recent pay stubs, a tax return, or a Social Security statement, and proof of your assets, such as bank statements.

The Social Security Administration processes the request and notifies you of the decision within 30 days in most cases. If you are approved, your Extra Help status takes effect on the first day of the month after you are approved. If you applied retroactively — meaning you applied after the year had already started — the program may backdate your benefit to January 1 of that year, and you may receive a refund for what you already paid out of pocket.

What Happens If Your Income Changes During the Year

Extra Help is based on your expected income for the entire year. If your income drops during the year — because you retired, lost a job, or had a reduction in benefits — you can request a review at any time. Social Security will recalculate your benefit based on your new income, and the change takes effect the first day of the month after you report it.

If your income rises above the limit, your Extra Help ends. Social Security will notify you, and you will be responsible for the full cost of your Part D premiums and copayments starting the next month. If you expect your income to drop again later in the year, you can request another review then.

You do not need to wait for an annual renewal to report a change. Call Social Security, visit your local office, or update your information online through Medicare.gov. Keep records of the change — such as a letter from your employer, a notice from Social Security, or a pension statement — because Social Security will ask for proof.

Asset Limits and What Counts as Savings

The program counts liquid assets — money you can access quickly — but not your home or most retirement accounts. Bank accounts, savings accounts, money market accounts, and certificates of deposit all count. Stocks, bonds, and mutual funds count. If you own a second property, its value counts as an asset.

Your primary home does not count, no matter how much it is worth. Your car does not count. Individual Retirement Accounts (IRAs), 401(k)s, and pension accounts do not count as assets for Extra Help purposes, even though they are counted for other means-tested programs. Life insurance policies do not count. If you are unsure whether a specific asset counts, ask Social Security when you explore.

If your assets are just above the limit but your income is well below it, you may still be denied. However, you can spend down your assets by paying medical bills, home repairs, or other legitimate expenses, and then reapply. Social Security does not penalize you for reducing your assets to meet the limit.

How to Request Extra Help and What Documents You Need

You have three ways to request Extra Help: online through Medicare.gov, by phone with Social Security, or by mail. The online route is fastest. Go to Medicare.gov, select "explore for Extra Help," and fill out the form with your income and asset information. You will need your Social Security number, your Medicare number, and information about your income and savings. You can upload documents or mail them later.

If you call Social Security at 1-800-772-1213, a representative will walk you through the questions and tell you what documents to send. The phone line is open Monday through Friday, 7 a.m. to 7 p.m. Eastern time. If you prefer to mail your process, request Form SSA-1020-U2 from your local Social Security office or read it from ssa.gov. Mail the completed form with copies of your proof documents to the address on the form.

Proof of income can be a recent tax return, a pay stub, a Social Security statement, a pension letter, or a bank statement showing regular deposits. Proof of assets is typically bank statements, investment account statements, or property records. You do not need to provide original documents — copies are fine. If you do not have a document, write a statement explaining your income or assets, and Social Security will follow up if they need more information.

What Extra Help Actually Pays for Your Prescriptions

Extra Help covers your Part D premium (the monthly fee), your deductible (the amount you pay before the plan starts paying), and your copayments or coinsurance (what you pay when you fill a prescription). The amount the program pays depends on your income. If your income is very low, Extra Help covers nearly all of these costs. If your income is closer to the limit, you pay a small share and Extra Help covers the rest.

The program does not change which drugs your plan covers or which pharmacy you use. You still choose a Part D plan, and that plan's formulary (list of covered drugs) still applies. Extra Help straightforward reduces what you owe out of pocket. If your plan's copayment is $10 and Extra Help covers 80 percent of it, you pay $2 and Extra Help pays $8.

Once you are approved for Extra Help, your Part D plan is notified automatically. You do not need to tell the plan yourself. Your insurance card will be updated to show your new copayment amounts, and your pharmacy will see the Extra Help subsidy when they process your prescription. If your copayment amounts do not change after you are approved, contact your plan to confirm they received your Extra Help status.

Frequently Asked Questions

Can I get Extra Help if I am still working?

Yes. Extra Help is based on your total household income, not your employment status. If you work part-time and your total income — including wages, Social Security, pensions, and other sources — falls below the limit, you may be within range. Report all sources of income when you explore.

What if I am married but my spouse does not have Medicare?

Your spouse's income still counts toward your household income limit, even if they are not enrolled in Medicare. If you are married and living together, Social Security counts both incomes. If you are separated or divorced, only your income counts.

Do I lose Extra Help if I move to a different state?

No. Extra Help is a federal program, and your status follows you if you move. Notify Social Security of your new address so they can send notices to the correct location. Your Extra Help benefit does not change.

Can I appeal if I am denied Extra Help?

Yes. If Social Security denies your request, the notice will explain why and tell you how to appeal. You have 60 days to request a reconsideration. If you believe your income or assets were calculated incorrectly, submit additional documentation with your appeal.

What happens to Extra Help when I turn 65 and enroll in Medicare?

If you were already receiving Extra Help before age 65, your status continues. If you are newly turning 65 and enrolling in Medicare for the first time, you can request Extra Help at the same time you enroll in Part D. Your Extra Help status takes effect when your Part D coverage begins.