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Extra Help for Medicare Part D: How It Works and Who Qualifies

Prescription drug costs can add up quickly, even if you already have a Medicare Part D plan. Extra Help is a federal program designed to lower those costs for people with limited income and resources, often saving them hundreds or more each year on medications.

What Is Extra Help?

Extra Help (also called the Low-Income Subsidy, or LIS) is a Medicare program that helps pay for:

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Monthly Part D premiums (sometimes the full premium for certain plans)
Annual deductible, if your plan has one
Drug copays or coinsurance at the pharmacy
Costs during the coverage gap (“donut hole”)

If you qualify, you keep your Medicare drug coverage through a Part D plan, but your share of the costs is reduced under the Extra Help rules.

Who Automatically Gets Extra Help?

You automatically qualify and do not need a separate application if you:

Have both Medicare and full Medicaid coverage, or
Are enrolled in a Medicare Savings Program (MSP) that helps pay your Part B premium, or
Receive Supplemental Security Income (SSI) (but not just Social Security retirement or disability alone)

If you fall into one of these groups, you should receive a notice in the mail about Extra Help and how it applies to your coverage.

Income and Resource Limits

Others can still get Extra Help based on income and resources. The limits change periodically, but generally the program is for people with low to moderate income and limited savings.

Resources usually include:

Money in checking and savings accounts
Investments like stocks and bonds

They generally do not include your home, one car, household items, or a burial plot. Because the exact limits and details change, it’s important to check current guidelines or talk with Social Security or your State Health Insurance Assistance Program.

How to Apply for Extra Help

If you’re not automatically enrolled, you can apply:

Through Social Security: by mail, over the phone, or online
With help from State Health Insurance Assistance Programs (SHIPs), local aging offices, or community organizations

You can apply any time of year. If you qualify, Extra Help usually begins as soon as your application is processed and can be applied to your current Part D plan.

What Extra Help Means for Your Drug Costs

With Extra Help, your monthly premium may be reduced or fully covered for certain plans, and your copays at the pharmacy are capped at lower amounts than standard Part D cost-sharing. You also avoid or greatly reduce:

The annual deductible
Higher out-of-pocket costs in the donut hole
Some late-enrollment penalties for Part D

If your income or resources change, your Extra Help level may change, but in many cases you’ll be reviewed automatically.

Understanding Extra Help is important if you ever skip medications because of cost. If your income and savings are limited, applying is often worth it—even if you’re not sure you’ll qualify—because the potential savings on prescriptions can be significant.