Medicare Extra Help: Part D Low-Income Subsidy (2026)

Extra Help caps a person's prescription drug costs at $5.10 for a generic and $12.65 for a brand-name drug in 2026, and those figures are ceilings rather than flat prices. The poorest people it covers pay $1.60 and $4.90, some pay nothing at all, and everyone pays nothing once they 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.1

What Medicare 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 up to your service area's regional benchmark premium. CMS pays that subsidy straight to your drug plan, so a plan priced at or below the benchmark costs you nothing. If you choose a more expensive plan, you are responsible for the difference between the benchmark premium and that plan's premium.1
• It eliminates the Part D deductible: under Extra Help the plan deductible is $0.1
• It caps what you pay per prescription at $5.10 for a generic and $12.65 for a brand-name covered drug in 2026, and many people pay less than that.1
• It drops your cost to $0 for the rest of the year once your out-of-pocket spending reaches the annual cap.1

Those copay figures are a ceiling, not a flat price, and that distinction matters most for the people with the least. CMS sets 2026 Extra Help copays as a three-rung ladder, and where you land on it depends on whether you also have full Medicaid and where your income falls.1

Those are the maximum copays below the yearly out-of-pocket threshold, and the Part D deductible is $0 in every one of those categories. Above the threshold there is no cost-sharing at all.1

If you're comparing plans for 2027, CMS has already set the new maximums. The deductible stays $0 in every category, and the $0 rung for people in an institution or on home and community-based services doesn't change. People with full Medicaid at or below 100% of the Federal Poverty Level pay at most $1.65 for a generic or preferred multi-source drug and $5.00 for all other drugs. Everyone on the top rung pays at most $5.80 and $14.40. Those copays apply up to the 2027 out-of-pocket threshold of $2,400, and covered drugs cost $0 after that.3

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 sooner than your own pharmacy receipts suggest, because the spending counted toward the $2,100 includes certain payments made on your behalf, such as payments through Extra Help itself, and not only the small capped copays you hand over at the counter.2

Do you qualify for Medicare Extra Help in 2026?

Extra Help is based on two things: your income and your countable resources. Both have to fall under a limit. The 2026 figures in the table below are the ones medicare.gov prints in its 2026 income and resource limits table. The income limits are 150% of the 2026 federal poverty guidelines for a one-person and a two-person household. The CMS resource and cost-sharing memo for the low-income subsidy states the resource limit in a lower base form, before the burial allowance Social Security adds, which is explained below the table.1

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.1

The resource figures in that table, $18,090 for an individual and $36,100 for a married couple, are the ones medicare.gov prints and the ones Social Security applies by default, so they're the ones to measure yourself against. They include a $1,500 burial allowance ($3,000 for a couple) that Social Security adds automatically. The lower base limits CMS publishes, $16,590 and $33,100, apply only if you report that none of your resources will be used for funeral or burial expenses. So if your savings sit somewhere between $16,590 and $18,090, don't assume you're over the line.1

Those income figures are the ones used in the 48 contiguous states and the District of Columbia. If you live in Alaska or Hawaii, don't measure yourself against them. Both states are figured from higher federal poverty guidelines, $19,950 in Alaska and $18,360 in Hawaii for one person in 2026 against $15,960 in the contiguous 48, so the Extra Help income limits run higher there than the numbers in the table. Medicare treats "What are the income and resource limits if I live in Alaska or Hawaii?" as a separate question for that reason, so check your figure with medicare.gov or Social Security before you decide you earn too much.1

A few things to know about how these limits actually work. The income figures are approximate, so don't rule yourself out if you're a little over. They're also the limits for a one-person and a two-person household, not a ceiling on everyone: the limit rises with household size, and a relative who lives with you and gets at least half their support from you or your spouse counts as part of your household. Social Security doesn't count all of your income, either. Part of what you earn from work is excluded, the income exclusions used for SSI apply to Extra Help too, and all interest and dividends are left out entirely. The figures above are the 2026 ones, and they're higher than any figure worked out from a prior year's poverty guidelines, so check the year on any limit you compare yourself against.1

The resource limit is similar. It counts cash and anything you could turn into cash within 20 workdays, such as savings, checking, and time-deposit accounts, mutual fund shares, and retirement accounts including IRAs and 401(k)s, plus your equity in real estate other than your home. It does not count your home, your car or any other vehicle, your household goods and personal belongings, the cash value of life insurance, burial spaces, or an irrevocable burial trust or contract. Social Security applies the SSI program's resource exclusions to Extra Help as well, so that list isn't complete. Many people who assume they have too much in savings are still under the limit once the exempt items come out.1

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.5
• A Medicare Savings Program that helps pay your Part B premium.4
• Supplemental Security Income (SSI), which Social Security treats as automatic Extra Help.1

If any of those apply to you, the Social Security Administration and CMS already have what they need, and you shouldn't fill out an Extra Help application. CMS notifies you that you don't need to apply. Keep that notice.1 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, and there's no cost to apply. Extra Help isn't available in Puerto Rico, the U.S. Virgin Islands, Guam, the Northern Mariana Islands, or American Samoa, so there's no application to file in those areas; call your State Medical Assistance (Medicaid) office about the other programs available there instead.1 You can apply two ways:

• Online, through the Extra Help application on the Social Security website.1
• By phone, by calling Social Security at 1-800-772-1213 (TTY 1-800-325-0778) and telling the representative you want to set up an appointment to apply for Part D Extra Help.1,6

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.

Learn More

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.