Extra Help is a Medicare program that helps people with limited income and resources pay for Medicare drug coverage (Part D), including premiums, deductibles, coinsurance and other costs (Medicare.gov). Some people get it automatically. Everyone else applies through Social Security, online or by phone, at any time of year. While you get Extra Help, you also won't pay a Part D late enrollment penalty.
Table of contents
- What does Extra Help pay for?
- Who gets Extra Help automatically?
- What are the income and resource limits in 2026?
- What counts as income and resources?
- How do you apply?
- What happens after you qualify?
- What if your pharmacy charges the wrong amount?
- Frequently asked questions
- Sources
- About the author
What does Extra Help pay for?
Extra Help lowers what you pay for Medicare drug coverage. Here's what you'll pay with Extra Help in 2027:
- Plan premium: $0 (Medicare.gov)
- Plan deductible: $0 (Medicare.gov)
- Up to $5.80 for each generic drug and up to $14.40 for each brand-name drug, for prescriptions filled at one of your plan's participating pharmacies (Medicare.gov)
- Once your total drug costs reach $2,400, including certain payments made for you through Extra Help, you pay $0 for each covered drug (Medicare.gov)
If you also get full Medicaid coverage and are in the Qualified Medicare Beneficiary (QMB) program, you'll pay no more than $4.90 for each covered drug (Medicare.gov).
Payments made for you through Extra Help count toward the yearly Part D out-of-pocket cap, the same cap that applies to everyone with Medicare drug coverage. To see how that cap works, read The Part D out-of-pocket cap and the old coverage gap.
Extra Help also removes the Part D late enrollment penalty while you have it. If you had a penalty before you got Extra Help, it goes away. For people who don't get Extra Help, the late enrollment penalties page shows how that penalty is figured.
Extra Help isn't available in Puerto Rico, the U.S. Virgin Islands, Guam, the Northern Mariana Islands or American Samoa. Those areas have other programs, and the State Medical Assistance (Medicaid) office there can explain them.
Who gets Extra Help automatically?
You get Extra Help automatically if you get any of these:
- Full-benefit Medicaid coverage
- Help from your state paying your Part B premiums, through a Medicare Savings Program
- Supplemental Security Income (SSI) payments from Social Security
If you qualify automatically, you'll get a notice in the mail. It tells you how much you'll pay and, if you don't already have one, your new Medicare drug plan. You don't need to apply, so keep that notice with your Medicare papers.
What are the income and resource limits in 2026?
In most cases, you qualify for Extra Help if your income and resources are below a certain limit, and those limits may go up each year. For 2026, they are:
- Individual: income limit $23,940 and resource limit $18,090 (Medicare.gov)
- Married couple: income limit $32,460 and resource limit $36,100 (Medicare.gov)
Income limits are higher in Alaska and Hawaii. Here in Florida, these are the limits that apply to you. Because the numbers change, check Medicare.gov for the current year before you decide whether to apply. If you're close to a limit, don't rule yourself out: applying is the way to find out, because Social Security reviews your financial information when you apply.
What counts as income and resources?
Not everything you have counts. Here's how it breaks down.
Income that counts includes Social Security benefits, pensions, annuities, wages, earnings from self-employment, rental income, alimony, Veterans benefits, Railroad Retirement Board benefits and worker's compensation.
Income that doesn't count includes help from others to pay household expenses, SNAP, housing assistance, home energy assistance, disaster assistance, earned income tax credit payments, medical treatment and drugs, scholarships and education grants, and victim compensation payments.
Resources that count include money in checking, savings and retirement accounts, stocks and bonds.
Resources that don't count include your home, one car, a burial plot, money you have put aside for burial expenses up to the limit Medicare.gov lists, furniture, and other household and personal items.
How do you apply?
You apply through Social Security, and you can do it any time before or after you enroll in Part D. Social Security offers two ways:
- Online. Social Security asks for your financial information on the application, and you can come back to finish an application you started.
- By phone. Call 1-800-772-1213 and tell the representative you want to set up an appointment to apply for Part D Extra Help. TTY users can call 1-800-325-0778. Appointments are available in most U.S. time zones, Monday through Friday, 8 a.m. to 7 p.m., in English, Spanish and other languages.
Before you start, it helps to gather these documents for you and your spouse:
- Bank statements and tax returns
- IRA or 401(k) account balances
- Statements for pensions, Veterans benefits, annuities and Railroad Retirement Board benefits
The same application can start a Medicare Savings Program application. Medicare Savings Programs are state programs that help with other Medicare costs, like premiums. Social Security will send your information to your state to start that application unless you tell them not to on the Extra Help application.
Your State Health Insurance Assistance Program (SHIP) can also help you apply.
What happens after you qualify?
If you don't have a Medicare drug plan, Medicare enrolls you in one so you get the cost savings you qualify for. You'll get a notice about your new plan, and you can pick a different Medicare drug plan if you want.
You keep Extra Help for the rest of the calendar year, through December 31, even if your income changes in the middle of the year. If you meet the limits for the next year, you keep it. Medicare or Social Security mails you a notice only if you no longer qualify or you are moved to a different plan for the next year. No notice means you keep Extra Help and the same plan.
Most people with Medicare can only switch plans at certain times of the year. If you have Medicaid or get Extra Help, you may be able to change your drug coverage once per month. Before you switch, check the new plan's drug list against the drugs you take; Part D drug coverage shows how.
If you qualify but aren't in a drug plan yet, Medicare's Limited Income Newly Eligible Transition (LI NET) program gives temporary Part D drug coverage. If you paid for covered Part D drugs after you qualified for LI NET, you may be able to get some money back. Keep your receipts and call LI NET at 1-800-783-1307 (TTY 711), 8 a.m. to 7 p.m. Eastern time.
What if your pharmacy charges the wrong amount?
If you qualify for Extra Help and think you're paying the wrong amount, contact your drug plan first. The plan may ask for proof that you get Extra Help, such as:
- The letter from Medicare saying you qualify for Extra Help or that your Extra Help is changing next year, printed on yellow, green, purple or orange paper
- Your award letter from Social Security, if you get SSI
- A document from your state showing you have Medicaid, like your Medicaid card or award letter
Tell your plan how many days of medication you have left. Your plan and Medicare will try to fix the issue before you run out. You can also call 1-800-MEDICARE (1-800-633-4227), TTY 1-877-486-2048, to learn your level of Extra Help and get your costs corrected with the plan.
Not sure how Extra Help fits with the drug plan you have now? Ask me, and I'll go over it with you: Ask Jeannie to reach out. Jeannie Pond is a Licensed Insurance Agent in Florida.
We do not offer every plan available in your area. Currently we represent 14 organizations which offer 52 products in your area. Please contact Medicare.gov or 1-800-MEDICARE to get information on all of your options.
1-800-MEDICARE (1-800-633-4227), TTY 1-877-486-2048, 24 hours a day/7 days a week
Frequently asked questions
Do I have to be in a Part D plan before I apply for Extra Help?
No. You can apply for Extra Help any time before or after you enroll in Part D. If you qualify and don't have a Medicare drug plan yet, Medicare will enroll you in one so you get the savings, and you can pick a different plan if you want.
Will I owe the Part D late enrollment penalty if I get Extra Help?
No. You won't pay a Part D late enrollment penalty while you get Extra Help, and a penalty you had before goes away. When Extra Help ends, you could get the penalty again unless you keep Medicare drug coverage or other creditable coverage, so join a drug plan within 2 months of losing Extra Help.
What happens if my income changes during the year?
You keep Extra Help through December 31 of that calendar year, even if your income changes in the middle of the year. If you meet the limits for the next year, you keep it, and Medicare or Social Security mails a notice only if you no longer qualify or are moved to a different plan.
I was turned down. Can I apply again?
Yes. You can reapply for Extra Help any time if your income and resources change.
Sources
- Help with drug costs, Medicare.gov, checked October 2, 2026
- Apply for Medicare Part D Extra Help program, Social Security Administration, checked October 2, 2026
About the author
Vista Insurance Services is a Florida fictitious name registered to Vista Consultants LLC, a Florida insurance agency (agency license L135539) with Jeannie Pond as agent in charge. Jeannie Pond is a Licensed Insurance Agent, NPN 8940178, licensed since 2009.