What Social Security Extra Help Actually Covers

Social Security Extra Help is a federal program that pays part or all of your prescription drug costs if you receive Social Security and have limited income and resources. It does not cover doctor visits, hospital stays, or other medical expenses — only the premiums, deductibles, and copayments for prescription drugs under Medicare Part D.

The program is officially called the Low-Income Subsidy (LIS) program, though Social Security and Medicare both call it Extra Help. If you receive it, your costs are capped: in 2024, you pay no more than $11.20 per month in premiums for a standard plan, and your annual out-of-pocket drug costs are limited to $7,050 (this figure changes each year). Without Extra Help, those costs can easily exceed $100 per month in premiums alone, plus much higher copayments.

The program is automatic in one narrow case: if you receive Supplemental Security Income (SSI) or certain state information programs, you are enrolled in Extra Help without having to do anything. In all other cases, you must take a step to be considered.

Key Takeaways

  • Extra Help covers only prescription drug costs under Medicare Part D, not other medical expenses, and you must already be enrolled in Part D to receive it.
  • Your income and resources must fall below federal limits, which vary by household size and change each year — for 2024, the income limit for a single person is roughly $21,000 annually.
  • If you receive SSI or certain state programs, you are automatically enrolled; otherwise, you must contact Social Security to be considered.
  • Social Security processes Extra Help requests year-round, and you can start receiving help within weeks of being approved.
  • Your circumstances change — income, resources, or household size — you should report the change to Social Security, as it may affect your benefit amount.

Income and Resource Limits for 2024

Extra Help has two separate financial tests: one for income and one for resources (savings, investments, property other than your home). You must pass both to receive the full benefit. If your income is slightly above the limit but your resources are very low, you may still receive a partial subsidy.

For 2024, the gross monthly income limit for a single person is approximately $1,773 per month, or $21,276 per year. For a married couple living together, the limit is roughly $2,382 per month, or $28,584 per year. These figures include Social Security, pensions, wages, interest, and most other income — but not Supplemental Security Income itself. If you live with others who are not your spouse, the limits are higher and depend on how many people are in your household.

For resources, you can own up to $15,000 if you are single, or $30,000 if you are married. Resources include bank accounts, stocks, bonds, and retirement accounts you can access — but not your home, your car, or life insurance policies. If you are over the resource limit, you do not automatically lose Extra Help; Social Security will look at your situation more closely.

These limits change each year, usually in January. If you are close to the limit, ask Social Security for the current year's figures before you assume you do not may have access to.

How to Request Extra Help From Social Security

The fastest way to request Extra Help is to call Social Security at 1-800-772-1213 and ask to speak with someone about the Low-Income Subsidy program. Have your Social Security number, date of birth, and a list of your current income sources ready. The call usually takes 15 to 20 minutes, and Social Security will ask you questions about your income, resources, and household size.

You can also explore in person at your local Social Security office, or by mail using Form SSA-1020 (process for Extra Help with Medicare Prescription Drug Plan Costs). The form is available on the Social Security website or at any Social Security office. If you explore by mail, include copies of recent documents that show your income — a recent pay stub, a bank statement, or a letter from your pension provider. Social Security will contact you if they need more information.

A third option is to explore through Medicare directly at Medicare.gov or by calling 1-800-MEDICARE (1-800-633-4227). Medicare can forward your request to Social Security, though Social Security will still be the one to make the final decision. This route works well if you are already on the phone with Medicare about your Part D plan.

Whichever way you explore, Social Security typically makes a decision within two to four weeks. You will receive a letter in the mail telling you whether you were approved, what your monthly premium will be, and what your copayments will be. If you are approved, the benefit usually starts the month after you are notified.

What Documents You Will Need

Social Security will ask you to provide proof of your income and resources. Have these documents ready before you call or visit:

  • Recent pay stubs (last two months) if you work
  • Social Security benefit statement (you can view this on ssa.gov under "My Social Security")
  • Pension or annuity statements
  • Bank statements (last two months) showing savings and checking accounts
  • Statements for stocks, bonds, mutual funds, or retirement accounts (IRAs, 401(k)s)
  • Proof of any other income, such as rental income or interest
  • Proof of citizenship or legal residency (birth certificate, passport, or green card)

You do not need to send all of these at once. Social Security will tell you which ones they need based on your situation. If you do not have a document, ask Social Security what they will accept instead — a letter from your bank or employer can sometimes work.

What Happens If Your Income or Resources Change

If you are receiving Extra Help and your circumstances change — you get a raise, you inherit money, someone moves in or out of your home, or your household size changes — you should report the change to Social Security. Call 1-800-772-1213 and tell them what changed and when.

Social Security will recalculate your benefit based on the new information. If your income goes above the limit, your Extra Help may be reduced or end. If your income drops, your benefit may increase. Changes usually take effect the month after Social Security processes them, though in some cases they can be backdated if you report them quickly.

You do not have to wait for Social Security to ask you. In fact, reporting changes promptly can prevent overpayments that you would have to repay later. Social Security also reviews Extra Help cases once a year, usually around the time your Medicare coverage renews, to make sure your benefit is still correct.

Extra Help and Your Medicare Part D Plan

Extra Help works with any Medicare Part D prescription drug plan you choose. When you enroll in a Part D plan, tell the plan that you have Extra Help — they will adjust your costs automatically. Your copayments and deductibles will be much lower than they would be without the subsidy.

If you are already enrolled in a Part D plan and then receive Extra Help, the plan will update your costs within a few days. You do not need to switch plans or do anything else. However, if you want to switch to a different Part D plan, you can do so during the annual enrollment period (October 15 to December 7 each year) or if you have a may have access to life event, such as a move or a change in income.

Some Part D plans are specifically designed for people with Extra Help and offer lower copayments. When you are choosing a plan, check whether it is flagged as an Extra Help plan. These plans often have $0 or $1 copayments for generic drugs and $3 to $5 for brand-name drugs, compared to $5 to $10 or more on other plans.

Frequently Asked Questions

Do I have to be on Medicare Part D to get Extra Help?

Yes. Extra Help only works with Part D prescription drug plans. If you are not enrolled in Part D, you should enroll first, then request Extra Help. You can enroll in Part D during the annual enrollment period or if you have a may have access to life event, such as losing other drug coverage.

What if I am already receiving SSI or Medicaid?

If you receive Supplemental Security Income (SSI) or certain state Medicaid programs, you are automatically enrolled in Extra Help without having to do anything. You will receive a notice in the mail confirming your enrollment. If you do not receive a notice within a few months of becoming may be able to access for SSI, contact Social Security to make sure you are enrolled.

Can I get Extra Help if I am not yet 65?

Yes, if you receive Social Security Disability Insurance (SSDI) or have end-stage renal disease, you are may be able to access for Medicare and can request Extra Help. The income and resource limits are the same as for people over 65. Contact Social Security to request Extra Help.

What if Social Security denies my request?

If Social Security denies your request, they will send you a letter explaining why. You have the right to ask for reconsideration within 60 days of the denial letter. Call Social Security and ask to file a reconsideration request, or submit a written request to your local Social Security office. Social Security will review your case again and may approve you if new information is provided.

Does Extra Help count as income for other benefits?

No. Extra Help is not counted as income when determining your may be able to access for other programs like Medicaid, SSI, or SNAP. It is a subsidy that reduces your out-of-pocket costs but does not increase your reported income.