Extra Help can cut a person's prescription drug costs to about $5 for a generic and under $13 for a brand-name drug, with nothing to pay once you hit the yearly cap. It's a federal benefit, also called the Part D Low-Income Subsidy, that lowers what people with limited income and savings pay for Medicare drug coverage. This guide explains who qualifies in 2026, what the benefit is worth, who gets it automatically, and how to apply.
What Extra Help is worth
Extra Help pays down the costs that make a Part D plan expensive: the monthly premium, the yearly deductible, and the copay at the pharmacy counter. For someone living on a fixed income, that's often the difference between filling a prescription and skipping it.
Here's what matters most about the benefit as it stands in 2026. Until 2024, Extra Help came in two levels, a full subsidy and a smaller partial one, and which you got depended on exactly where your income fell. The Inflation Reduction Act ended that split. The partial tier is gone, so everyone who qualifies now receives the full subsidy. There's no longer a reduced version to land in.
Full Extra Help does four things for your drug coverage:
- It pays your Part D premium, in full, up to a regional benchmark amount (most plans at or below that benchmark cost you nothing).
- It eliminates the Part D deductible.
- It caps what you pay per prescription at $5.10 for a generic and $12.65 for a brand-name covered drug in 2026.
- It drops your cost to $0 for the rest of the year once your out-of-pocket spending reaches the annual cap.
That last point connects to a separate 2026 change. Under the Part D redesign, every enrollee's out-of-pocket drug spending is now capped at $2,100 for the year, after which covered drugs cost nothing, according to the Centers for Medicare and Medicaid Services. With Extra Help, you reach that $0 point having paid only the small capped copays along the way.
Do you qualify in 2026?
Extra Help is based on two things: your income and your countable resources. Both have to fall under a limit, and the 2026 figures come from the CMS resource and cost-sharing memo for low-income subsidy.
The income limit is 150% of the Federal Poverty Level. The resource limit covers money you have in savings and certain investments, with some things left out of the count entirely.
| Household | Monthly income (about) | Yearly income (about) | Resource limit |
|---|---|---|---|
| Individual | $1,995 | $23,940 | $16,590 |
| Married couple living together | $2,705 | $32,460 | $33,100 |
A few things to know about how these limits actually work. The income figures are approximate because the Federal Poverty Level updates each year, and the program builds in some adjustments, so don't rule yourself out if you're a little over. Social Security doesn't count every dollar you bring in, and it disregards a portion of your income when it runs the test.
The resource limit is similar. It counts things like checking and savings accounts, stocks, and bonds. It does not count your home, your car, your personal belongings, or your burial plot. Many people who assume they have too much in savings are still under the limit once the exempt items come out.
If your income or resources sit just above these lines, it's worth applying anyway. The worst outcome is a denial, and the rules leave more room than the headline numbers suggest.
Who gets Extra Help automatically
Not everyone has to apply. If you already have certain other coverage, you're enrolled in Extra Help automatically, without filling out a form. You qualify automatically if you have any one of these:
- Full Medicaid coverage along with your Medicare.
- A Medicare Savings Program that helps pay your Part B premium.
- Supplemental Security Income (SSI).
If any of those apply to you, the Social Security Administration and CMS already have what they need. You should get a notice in the mail confirming your Extra Help, usually on colored paper, and it tells you what your drug costs will be. Keep that letter. If you think you should qualify automatically and haven't heard anything, that's a reason to call Social Security rather than wait.
Everyone else, people with limited income who don't have one of those three things, applies directly. That's the path the next section walks through.
How to apply
You apply for Extra Help through the Social Security Administration, not through your drug plan or Medicare directly. There's no cost to apply, and you can do it three ways:
- Online, through the application on the Social Security website. This is usually the fastest.
- By phone, by calling Social Security at 1-800-772-1213 (TTY 1-800-325-0778).
- In person, at your local Social Security office.
The application asks about your income, your savings and investments, and your household. You don't have to send in proof of everything up front, but it helps to have a sense of your account balances and income before you start. Social Security may follow up to verify what you reported.
A couple of points worth holding onto. Applying for Extra Help can also start the process for a Medicare Savings Program, since the two overlap, so the single application can open more than one door. And Extra Help isn't a one-time window. You can apply at any point in the year, and if your income or savings drop later, you can apply again even after an earlier denial.
Once you're approved, you still need to be enrolled in a Part D plan for the subsidy to do anything. If you don't pick one, you may be assigned a plan automatically so your benefit can take effect, but choosing your own plan lets you match it to the drugs you actually take.
Frequently asked questions
No, though they're closely related and many people qualify for both. Extra Help lowers your prescription drug costs under Part D. A Medicare Savings Program helps with Part A and Part B costs, mainly the Part B premium. Having a Medicare Savings Program is one of the things that qualifies you for Extra Help automatically, so it's common to have both at once.
Apply anyway. The income figures are approximate, the Federal Poverty Level changes each year, and Social Security doesn't count all of your income when it runs the eligibility test. People who assume they earn too much are often still under the line once those adjustments apply, so a denial is the only thing you risk by trying.
Extra Help lowers the cost of drugs covered by your Part D plan, but each plan has its own formulary, the list of drugs it covers. The capped copays apply to covered drugs. If a medication you take isn't on your plan's formulary, Extra Help doesn't change that, which is why it's worth choosing a Part D plan that covers your specific prescriptions.
No. Once you have Extra Help, it generally continues as long as you stay eligible. Social Security may check your eligibility from time to time and will contact you if it needs updated information. If your situation changes, for example your income rises above the limit, your benefit could change, but you don't have to file a fresh application each year to keep it.
It was eliminated in 2024 under the Inflation Reduction Act. Before then, some people qualified for a smaller, partial version of Extra Help. Now there's only one level. Everyone who qualifies gets the full subsidy, with the same capped copays and the same $0 cost after the yearly out-of-pocket cap.
Learn More
- What Is Medicare? Parts A, B, C, and D Explained
- Dual-eligible plans (FIDE-SNPs): Medicare and Medicaid together
Find personalized help applying for Extra Help and choosing a Part D drug plan at brevy.com.
The information on Brevy.com is for educational purposes only and is not a substitute for professional legal, financial, or medical advice. Rules vary by state and program and change frequently. Always verify with the relevant agency or a qualified professional. Brevy is not a law firm, financial advisor, or healthcare provider.