For a Georgia senior on Social Security alone, the cost of prescription drugs is often the single largest unmet need in Medicare. Even with Part D, a beneficiary taking 8-12 medications can easily face $200-$500 a month in out-of-pocket prescription costs, costs that lead to skipped doses, half-dosing, and the well-documented "cost-related non-adherence" that drives preventable hospital admissions.

The Extra Help program, known formally as the Part D Low-Income Subsidy (LIS), wipes out most or all of those costs. Created by the Medicare Modernization Act of 2003 alongside Part D itself, expanded by the Affordable Care Act, and broadened by the Inflation Reduction Act of 2022 (which eliminated the partial LIS tier and expanded full LIS to all beneficiaries up to 150% of the federal poverty level effective January 1, 2024), Extra Help is the single most valuable Medicare Part D cost-reduction program available to low-income Georgia seniors.

A large share of Georgia Medicare beneficiaries receive Extra Help, roughly half automatically through QMB or other dual eligible categories, and roughly half through direct application to the Social Security Administration. This standalone deep-dive explains how Extra Help works in Georgia, what the IRA 2022 expansion changed, how to apply through SSA, how Extra Help interacts with the Part D out-of-pocket cap, and how to fix the most common Extra Help problems.

By Brevy Care Team · Last verified May 14, 2026

## Key takeaways
  • Extra Help (Part D LIS) is the federal subsidy program that pays Medicare Part D premiums, deductibles, and cost-sharing for low-income beneficiaries.
  • 2026 LIS resource limits: $16,590 single, $33,100 couple per the CMS CY2026 LIS Resource Limits Memo; income at or below 150% FPL.
  • 2026 benefits: $0 premium for benchmark plans, $0 deductible, maximum copay per drug $12.65, $0 institutional copays, $0 after the Part D annual out-of-pocket cap.
  • Automatic enrollment: QMB, SLMB, QI, full dual eligibles, and SSI recipients are automatically deemed eligible for full LIS; no application required.
  • Apply through SSA at SSA.gov/extra-help or 1-800-772-1213; GeorgiaCares SHIP (1-866-552-4464) provides free application help.

The federal framework: how Extra Help was built and what the IRA changed

Origins under MMA 2003

The Part D Low-Income Subsidy was created alongside Medicare Part D itself by the Medicare Modernization Act of 2003 (MMA, PL 108-173). When Congress added prescription drug coverage to Medicare in 2003 (implementation began January 2006), it recognized that the cost of Part D premiums and copays would be prohibitive for low-income beneficiaries who had previously gotten their drugs through Medicaid, manufacturer assistance, or simply gone without. The LIS framework, codified at Section 1860D-14 of the Social Security Act, created a tiered subsidy structure:

  • Full LIS for beneficiaries with very low income/assets (originally below 135% FPL with very low assets), paying $0 premium, $0 deductible, and minimal copays.
  • Partial LIS for beneficiaries between 135% and 150% FPL, with a sliding-scale premium subsidy, a small deductible, and higher copays.

For nearly two decades the partial LIS tier created confusion and significant cost-sharing gaps for the working poor, the just-above-the-line, and beneficiaries with fluctuating income.

IRA 2022: the LIS revolution

The Inflation Reduction Act of 2022 (IRA, PL 117-169) restructured Part D in several historic ways, and the LIS overhaul is one of the most significant for low-income beneficiaries:

  • Effective January 1, 2024, the IRA eliminated the partial LIS tier entirely and extended full LIS benefits to all beneficiaries up to 150% FPL.
  • Effective January 1, 2025, the IRA capped Part D out-of-pocket spending for all Part D beneficiaries (not just LIS); the cap was $2,000 in 2025 and is $2,100 in 2026, indexed for inflation under the CMS 2026 Part D Bid Information notice.
  • Effective January 1, 2025, the IRA created the Medicare Prescription Payment Plan (M3P), a monthly payment smoothing program that lets beneficiaries spread the Part D OOP cap evenly across the year.
  • Effective January 1, 2026, the IRA implemented Medicare drug price negotiation for the first 10 selected drugs (with more added over time).

The 2024 LIS expansion was significant: many Medicare beneficiaries nationwide moved from partial LIS or no LIS to full LIS, with premium and copay reductions. In Georgia, a meaningful share of beneficiaries became newly eligible or saw their cost-sharing reduce as a result.

The current LIS framework is a single tier of full LIS for all beneficiaries up to 150% FPL, a dramatic simplification.

Extra Help eligibility in Georgia (2026)

A Georgia Medicare beneficiary qualifies for Extra Help if all four of the following are true:

1. Entitled to Medicare Part A or Part B

The beneficiary must be entitled to (eligible for) Medicare Part A or Part B. Most LIS beneficiaries also have Part D coverage, but Extra Help eligibility does not require already being enrolled in Part D.

2. Income at or below 150% FPL

Income is calculated using a modified Supplemental Security Income (SSI) methodology, with most earned and unearned income counted, and specific disregards including a $20 general income disregard and an Earned Income Disregard ($65 + half of remainder). For current 2026 income limits, consult the HHS Federal Poverty Level guidelines or the SSA Extra Help application page.

3. Assets at or below 2026 limits

For 2026:

Household size Asset limit
1 person $16,590
2 people (married, living together) $33,100

The LIS asset limit is substantially higher than the Georgia QMB asset limit ($9,660 single, $14,470 couple) and dramatically higher than the full Medicaid limit ($2,000 / $3,000), making Extra Help accessible to many seniors who would not otherwise qualify for QMB or Medicaid.

Countable resources:

  • Bank accounts, stocks, bonds, mutual funds, cash, second vehicles, non-principal real estate

Excluded resources:

  • Primary home, one car, household goods, burial spaces and funds up to $1,500, life insurance with face value at or below $1,500

4. Georgia residency

The applicant must reside in Georgia. There is no minimum length of residency.

What Extra Help pays in 2026

After the IRA 2022 simplification, all LIS beneficiaries up to 150% FPL receive the same level of full LIS benefits (with two subgroups for institutional and hospice beneficiaries):

Part D premium

  • $0 for benchmark plans (the lowest-cost Part D plans in Georgia, designated as benchmark by CMS).
  • LIS pays the full benchmark premium directly to the Part D plan.
  • If a beneficiary chooses a more expensive Part D plan, they pay the difference between the benchmark and the chosen plan's premium.

Part D annual deductible

  • $0; LIS pays the entire Part D deductible for the beneficiary. Consult the current CMS Part D parameters page for the specific 2026 deductible figure.

Prescription copays (2026)

  • Maximum copay per drug: up to $12.65 per prescription for full LIS beneficiaries (per the CMS CY2026 LIS schedule). Many beneficiaries pay less depending on drug tier.
  • $0 copays for full benefit dual eligibles in institutions (nursing facilities, ICF-IIDs)
  • $0 copays after reaching the Part D annual OOP cap (IRA 2022 catastrophic threshold)
  • No Part D coverage gap (donut hole); Extra Help skips the gap entirely

Annual OOP cap

  • Under IRA 2022 (effective 2025), all Part D beneficiaries, including LIS recipients, have an annual out-of-pocket cap. For 2026 the cap is $2,100 (indexed for inflation from $2,000 in 2025). After reaching the cap, copays are $0.
  • In practice, LIS beneficiaries rarely hit the cap because their copays are already so low.

Auto-enrollment in a benchmark plan

If a beneficiary qualifies for Extra Help but does not choose a Part D plan, CMS automatically enrolls them in a benchmark plan with $0 premium. CMS reassigns beneficiaries each year if their plan's premium rises above the benchmark.

Automatic enrollment vs. application

Auto-enrolled (no application required)

The following Medicare beneficiaries are automatically deemed eligible for full Extra Help:

  1. QMB beneficiaries, Qualified Medicare Beneficiary
  2. SLMB beneficiaries, Specified Low-Income Medicare Beneficiary
  3. QI beneficiaries, Qualifying Individual
  4. Full dual eligibles, beneficiaries with both Medicare and full Medicaid
  5. SSI recipients (Supplemental Security Income), even without Medicaid

When a beneficiary becomes any of the above, CMS automatically deems them eligible for full LIS. CMS sends a notice; the beneficiary does not need to apply separately. Auto-enrollment is retroactive to the date of dual eligible status.

Application required

All other beneficiaries below 150% FPL must apply for Extra Help. Application can be made through:

  1. Social Security Administration

    • Online: SSA.gov/extra-help
    • Phone: 1-800-772-1213
    • In person: local SSA office (find at SSA.gov)
    • Paper application: SSA-1020

  2. Georgia DCH (indirect): apply for Medicaid; if approved for full Medicaid, LIS is auto-activated.

  3. GeorgiaCares SHIP: free, unbiased application assistance at 1-866-552-4464.

Processing typically takes 30-60 days. Decisions are sent in writing with appeal rights.

How Extra Help interacts with the Part D OOP cap

The IRA 2022 capped all Part D out-of-pocket spending annually effective January 1, 2025. After reaching the cap, beneficiary cost-sharing drops to $0 for the remainder of the year. For 2026 the cap is $2,100.

For Extra Help beneficiaries, the interaction is straightforward:

  • LIS beneficiaries pay nominal copays (up to $12.65 per drug per the 2026 CMS LIS schedule).
  • These copays count toward the Part D OOP cap.
  • In practice, an LIS beneficiary taking 12 prescriptions per month at a low average copay will spend well below the cap each year.
  • LIS beneficiaries with high-cost specialty drugs (multiple sclerosis treatments, certain biologics) may hit the cap earlier, after which they pay $0.

The Medicare Prescription Payment Plan (M3P)

Also effective January 2025, the Medicare Prescription Payment Plan lets Part D beneficiaries elect to smooth their copays evenly across the year. Without M3P, a beneficiary might pay $500 for one month's prescription and $50 for another. With M3P, the total annual copay is divided evenly across 12 months. LIS beneficiaries can elect M3P but typically do not need to, given their low copays.

How to apply for Extra Help through SSA

Step 1: Gather documents

  • Medicare card
  • Social Security number
  • Bank statements (last 3 months for income, multiple months for assets)
  • Asset statements (investments, vehicles, life insurance)
  • Income proof: Social Security award letter, pension statements, pay stubs
  • Information about household (spouse income/assets, if applicable)

Step 2: Choose an application channel

Online (recommended for most):

  • Go to SSA.gov/extra-help
  • Complete the application (typically 30-45 minutes)
  • Submit electronically

Phone:

  • Call 1-800-772-1213 (TTY 1-800-325-0778)
  • Hours: 8 AM to 7 PM weekdays
  • An SSA representative will complete the application with you

In person:

  • Find the local SSA office at SSA.gov
  • Schedule an appointment (recommended) or walk in

Paper:

  • Request Form SSA-1020 from SSA or print it from SSA.gov
  • Mail to local SSA office

With SHIP assistance:

  • Call GeorgiaCares SHIP at 1-866-552-4464
  • A free SHIP counselor will walk you through the application

Step 3: Decision

SSA sends a decision letter within 30-60 days. If approved:

  • Letter explains LIS benefits
  • CMS auto-enrolls in a benchmark Part D plan (if not already enrolled)
  • LIS effective the month of approval (or earlier in some cases)

Step 4: Appeal if denied

Appeal rights are explained in the denial letter. You can appeal to:

  • SSA via reconsideration
  • SSA Administrative Law Judge if reconsideration denied
  • Federal court (rare for LIS)

GeorgiaCares SHIP can assist with appeals.

Georgia Extra Help landscape

A large share of Georgia Medicare beneficiaries receive Extra Help, with the population split roughly between those who are auto-deemed through dual eligible status and those who apply directly to SSA. Following the IRA 2022 expansion (effective January 2024), a meaningful share of additional Georgians newly qualified, many of whom had previously been on partial LIS or just over the eligibility threshold.

Oversight in Georgia:

14 best practices for Georgia families seeking Extra Help

  1. Apply even if you are not sure you qualify. The asset limits are generous ($16,590 single, $33,100 couple in 2026) and many seniors qualify who do not realize it.
  2. Use the NCOA BenefitsCheckUp tool at benefitscheckup.org or 1-800-794-6559 for free screening of LIS and 60+ other benefits.
  3. Apply through GeorgiaCares SHIP (1-866-552-4464) for free, unbiased application assistance.
  4. Apply for QMB and Extra Help together when possible. QMB applicants automatically qualify for LIS once QMB is approved.
  5. Verify auto-enrollment. If you are QMB, full Medicaid, SLMB, QI, or SSI, you should have automatic LIS. Confirm with SSA or your Part D plan.
  6. Choose a benchmark Part D plan to avoid paying any premium difference. CMS publishes the benchmark plans each year for Georgia.
  7. Do not switch to a non-benchmark plan unless the higher-cost plan covers a specific drug you need that the benchmark does not.
  8. Use the Plan Finder at Medicare.gov every fall during AEP to confirm your Part D plan is still the best fit, even with LIS.
  9. Carry your LIS notice when picking up prescriptions, in case there is a billing question at the pharmacy.
  10. Report changes promptly. Inheritances, lottery winnings, or job changes can affect LIS eligibility.
  11. Take advantage of the M3P option if your copays vary by month and you prefer even payments.
  12. Combine LIS with manufacturer patient assistance programs (PAPs) for drugs LIS does not fully cover.
  13. Annual recertification not always required. Auto-deemed beneficiaries are redetermined automatically. Direct-application beneficiaries may need to re-verify annually.
  14. Document everything. Application copies, income/asset proof, LIS approval letters: keep them in a file for reference.

14 common Extra Help issues Georgia families encounter

  1. Asset over-limit denial: applicant has a CD or second car pushing assets above the $16,590 single limit.
  2. Income over-limit: pension or part-time work pushes income above 150% FPL.
  3. Spouse income/assets: household calculations include spouse, sometimes pushing applicant over the limit.
  4. Missing auto-enrollment: QMB approved but LIS not auto-activated due to data lag; requires SSA follow-up.
  5. Wrong Part D plan auto-enrolled: CMS auto-enrolls in a plan that does not cover the beneficiary's drugs; beneficiary can change plans.
  6. Pharmacy billing the full retail price: pharmacy does not have LIS on file; beneficiary should show LIS notice or pharmacy can verify electronically.
  7. Application processing delays: SSA takes longer than 60 days; beneficiary advised to apply early.
  8. Confusion between SLMB and LIS: SLMB pays Part B premium only; LIS pays Part D costs. Different programs.
  9. Premium difference for non-benchmark plan: beneficiary chose a higher-cost plan and pays the difference unexpectedly.
  10. M3P confusion: beneficiary signs up for M3P but is confused by monthly bill from plan.
  11. Travel out of state mid-year: LIS continues but pharmacy network may differ; out-of-network claims may not be covered.
  12. Beneficiary does not realize old partial LIS converted to full LIS in 2024: should see lower copays starting January 2024.
  13. Manufacturer Discount Program confusion: under IRA, manufacturers fund part of Part D in the catastrophic phase; this is invisible to beneficiaries.
  14. Beneficiary fears applying will affect SSI/Medicaid: LIS application does not affect SSI or Medicaid; in fact, it is complementary.

Worked examples

Worked example 1: Margaret in Atlanta, auto LIS through QMB

Margaret, 72, of Atlanta, is approved for QMB. When DCH approves her QMB, CMS is notified electronically and automatically deems her eligible for full LIS within 30 days.

She is auto-enrolled in a Georgia benchmark Part D plan with $0 premium. Her copays on her prescriptions follow the LIS schedule (up to $12.65 per drug). Her total annual prescription costs drop sharply compared with what she would owe without LIS, and the benchmark premium is paid in full by LIS.

Worked example 2: James in Decatur, applied directly, just over QMB but qualifies for full LIS

James, 70, of Decatur, has Social Security retirement income just above the GA QMB income limit (~$1,305/month single per the GA MSP fact file) but below 150% FPL for LIS. His assets are well below the LIS limit ($16,590 single).

He applies for Extra Help directly through SSA.gov/extra-help. A SHIP counselor helps him with the application and he is approved for full LIS within about a month.

He is auto-enrolled in a benchmark Part D plan. His prescription costs drop substantially under LIS.

Note: Before IRA 2022 (pre-January 2024), James would have qualified for partial LIS only, paying a higher premium and higher brand copays. Under the IRA expansion he now gets full LIS benefits.

Worked example 3: Robert in Marietta, pre-IRA partial LIS converted to full LIS

Robert, 75, of Marietta, was on partial LIS from 2022 to 2023 (his income was around 140% FPL). He was paying small generic and brand copays plus a small Part D premium subsidy.

Effective January 1, 2024, the IRA expansion converted his partial LIS to full LIS automatically. His copays now follow the unified full-LIS schedule (up to $12.65 per drug), the premium dropped to $0 for a benchmark plan, and the deductible disappeared.

Most importantly, his Part D coverage gap (donut hole), which he occasionally hit before, no longer applies.

Worked example 4: Linda in Sylvester, rural application through SHIP

Linda, 70, of Sylvester (Worth County), has Social Security income well below 150% FPL. She is not on Medicaid because she has modest savings from selling her late husband's tools. She does not know about Extra Help until a GeorgiaCares SHIP counselor visits the Sylvester senior center.

The SHIP counselor helps her apply directly through SSA.gov/extra-help and she is approved within about a month.

She is auto-enrolled in a benchmark plan and her diabetes and CHF prescription costs drop sharply.

Worked example 5: David in Macon, high-cost specialty drug and the Part D OOP cap

David, 78, of Macon, has multiple sclerosis and is on a high-cost specialty drug (~$5,000/month list price). He is on full LIS (income just below 150% FPL).

His LIS brand copay is capped at $12.65 per drug under the CMS CY2026 LIS schedule. His total annual OOP is far below the $2,100 IRA 2026 cap.

Without LIS, even with the $2,100 OOP cap, David would have paid up to $2,100 out of pocket. LIS saves him additional dollars on top of the cap.

Worked example 6: Sarah in Gainesville, institutional $0 copay

Sarah, 82, of Gainesville, is a long-term resident of a Hall County nursing facility on Medicaid Nursing Home + Medicare. As a full benefit dual eligible in an institution, she has $0 copays for all Part D prescriptions.

She takes multiple prescriptions for advanced dementia, CHF, diabetes, and HTN. Without institutional $0 copays, she would have owed a significant monthly amount. With institutional LIS rules, her family's pharmacy out-of-pocket is $0.

Frequently Asked Questions

Extra Help is the federal Part D Low-Income Subsidy (LIS), a subsidy that pays Medicare Part D premiums, deductibles, and most prescription copays for low-income beneficiaries. Georgia beneficiaries qualify with income at or below 150% FPL, assets at or below $16,590 single ($33,100 couple) per the CMS CY2026 LIS Resource Limits Memo, entitled to Medicare Part A or B, and residing in Georgia.

It pays the Part D premium for benchmark plans and the annual deductible, and caps copays at up to $12.65 per drug under the CMS CY2026 LIS schedule. It also covers $0 institutional copays and $0 cost-sharing after the Part D annual out-of-pocket cap ($2,100 in 2026).

If you are a QMB, SLMB, QI, full Medicaid recipient, or SSI recipient, you are automatically deemed eligible for full LIS. No application required.

Apply through Social Security: SSA.gov/extra-help, 1-800-772-1213, or in person at a local SSA office. You can also get help from GeorgiaCares SHIP (1-866-552-4464). Processing typically takes 30 to 60 days.

Your LIS copays count toward the annual Part D OOP cap ($2,100 in 2026). After hitting the cap (rare for LIS beneficiaries with low copays), you pay $0 for remaining prescriptions for the rest of the year. There is no donut hole for Extra Help beneficiaries; you pay the same low LIS copays in all phases of Part D coverage.

A few more common questions:

Do I have to apply for Extra Help every year? Auto-deemed beneficiaries: no, redetermination is automatic. Direct-application beneficiaries: SSA reviews periodically; respond to any redetermination notice.

Can I lose Extra Help? Yes, if income or assets rise above the limits. Report changes to SSA promptly.

Does Extra Help cover Part B premiums or doctor visits? No. Extra Help is only for Part D prescriptions. Part B premium and medical costs are covered by Medicare Savings Programs (QMB, SLMB, QI).

Can I have Extra Help and Medicare Advantage? Yes. If your MA plan includes Part D (MA-PD), LIS reduces your prescription costs within the plan. Choose an MA-PD plan that is a benchmark or close to it.

Will applying for Extra Help affect my other benefits? No. Extra Help does not affect SSI, Medicaid, SNAP, or other benefits.

What if my application is denied? You can appeal SSA's decision. The denial letter explains appeal rights. GeorgiaCares SHIP can help with appeals.

Where can I get free help applying for Extra Help? GeorgiaCares SHIP at 1-866-552-4464. Also NCOA BenefitsCheckUp (1-800-794-6559) and Medicare Rights Center (1-800-333-4114).

Contacts and resources

  • Medicare 1-800-MEDICARE (1-800-633-4227)
  • Social Security Administration 1-800-772-1213 (LIS application)
  • SSA.gov/extra-help, online application
  • GeorgiaCares SHIP 1-866-552-4464, free LIS application help
  • Georgia SMP 1-866-552-4464, fraud reporting
  • Georgia Department of Community Health 1-866-211-0950
  • Georgia DFCS 1-877-423-4746
  • Georgia Department of Insurance 1-800-656-2298
  • Medicare Rights Center 1-800-333-4114
  • Atlanta Legal Aid Society 404-377-0701
  • Georgia Legal Services Program 1-800-498-9469
  • Eldercare Locator 1-800-677-1116
  • 211 Georgia, community resources statewide
  • AARP Foundation 1-888-227-7669
  • Patient Advocate Foundation 1-800-532-5274
  • NCOA BenefitsCheckUp 1-800-794-6559
  • NeedyMeds 1-800-503-6897, patient assistance programs
  • Partnership for Prescription Assistance, pparx.org

Find personalized help understanding Medicare Extra Help and Part D options at brevy.com.

BC

Brevy Care Team

Expert eldercare guidance from Brevy's team of healthcare professionals and researchers.