Medicare Extra Help 2026: Income Limits & Benefits

Extra Help, also called the Part D Low-Income Subsidy (LIS), is a program for Medicare Part D beneficiaries who have limited income and resources. It lowers or eliminates your drug plan premium, deductible, and copays. As of 2024, everyone who qualifies receives the full subsidy (the old partial benefit was eliminated). If you qualify for a Medicare Savings Program, you get Extra Help automatically.

What costs does Extra Help Cover?

Medicare Extra covers the following costs from your Part D coverage:

• Premium: Extra Help covers your Part D Premium, so that your costs are $0.
• Deductible: Extra Help covers your Part D deductible, so that your costs are $0.
• Copay/coinsurance: Extra Help covers some of the costs of your prescriptions, so you pay less for generic and brand-name drugs.

With Extra Help in 2026, you pay:

• A small copay for each generic drug (a few dollars), set by Medicare each year.
• A slightly higher copay for each brand-name drug.
• $0 for covered drugs once your out-of-pocket drug spending reaches the annual cap ($2,100 in 2026).

Additionally, if you are required to pay a late enrollment penalty on Part D, you will no longer be required to pay that fee while you get Extra Help.

Who gets Extra Help automatically?

You will get Extra Help automatically if you already get any of the following:
• Full Medicaid coverage
• Help from your state paying your Part B premiums (a Medicare Savings Program)
• Supplemental Security Income (SSI) benefits from Social Security

If you get Extra Help automatically, you will receive notice in the mail that will detail how much you’ll pay. You will also be enrolled in a Medicare Part D plan, if you are not in one already, and will be notified in the letter.

Once enrolled, your eligibility for Extra Help is reviewed each year. You will receive Extra Help benefits for as long as you remain eligible.

In the fall, you may get a notice if:
• You are no longer eligible for Extra Help, and will not receive benefits in the upcoming year.
• You get moved to a different drug plan for the upcoming year.

Who can apply for Extra help?

To be eligible for Extra Help, you must be below a certain level in income and resources. These limits change each year. You must also live in the United States or the District of Columbia. If you don’t qualify for Extra Help now, you can reapply at any time during the year if your income and resources, or the requirements, change.

What is the income limit for Extra Help?

For 2026, your annual income must be at or below $23,475 for an individual or $31,725 for a married couple living together (about 150% of the federal poverty level). Some income does not count toward this total, so you may still qualify even if you earn a little more.

What is the resource limit for Extra Help?

For 2026, your resources must be at or below $18,090 for an individual or $36,100 for a married couple living together (these amounts include a $1,500 per person set-aside for burial expenses).

Source and date: 2026 income and resource limits from the Social Security Administration. Limits update each year, typically in the fall.

Resources include the value of the things you own. Some examples are:
• Real estate (other than your primary residence).
• Bank accounts, including checking, savings, and certificates of deposit.
• Stocks.
• Bonds, including U.S. Savings Bonds.
• Mutual funds.
• Individual Retirement Accounts (IRAs).
• Cash at home or anywhere else.

The things that are not counted include:
• Your primary residence.
• Personal possessions.
• Any vehicles.
• Property you need for self-support, such as rental property or land you use to grow produce for home consumption.
• Non-business property essential to your self-support.
• Life insurance policies.
• Burial expenses.
• Interest earned on money you plan to use for burial expenses.

How to apply for Extra Help

If you are not enrolled automatically, applying is free and takes about 30 minutes. You can apply three ways:

• Online at SSA.gov (search "Apply for Extra Help").
• By phone at 1-800-772-1213 (TTY 1-800-325-0778).
• In person at your local Social Security office.

When you apply, Social Security also forwards your information to your state to check whether you qualify for a Medicare Savings Program, so one application can start help with both your drug costs and your Part B premium.

What happens once I start getting Extra Help?

If you are not already in a Medicare Part D drug plan, you’ll be enrolled in one once your Extra Help starts.

You’ll get a notice by mail telling you about your new plan. We recommend that you check to see if the drugs and pharmacies you use are covered. If not, you may pick a different Medicare drug plan. You will get Extra Help for the rest of the calendar year. Even if your income changes in the middle of the year, you’ll get these benefits through December 31.

If Medicare enrolls you in a drug plan, you will receive a notice letting you know when your coverage begins.

What if I get enrolled in a Part D plan that isn’t right for me?

On Extra Help, you may be able to change plans one time during each of these periods:
• January to March
• April to June
• July to September

Your Part D plan will begin the first day of the next month. You can also switch drug plans each year during Medicare Open Enrollment (October 15 to December 7), and the new plan will take effect on January 1.

What if I paid too much for my drugs after I started getting Extra Help?

If you are eligible for Extra Help, but haven’t started Part D yet, you are qualified for Medicare’s LI NET program. The LI NET (Limited Income Newly Eligible Transition) Program gives you temporary drug coverage in this transitionary period. Some of the things this program provides include:
• Coverage for all Part D covered drugs
• no network pharmacy restrictions
• ensures you’ll only be charged a reduced copayment for your drugs
• May cover prescriptions previously filled within a certain timeframe

If you paid too much for prescription drugs once you started getting Extra Help benefits, and weren’t yet in a Medicare drug plan, you may be able to get back some of what you paid. Keep your receipts, and call Medicare’s LI NET Program at 1-800-783-1307.

What if I don’t qualify for Extra Help?

You can apply or reapply for Extra Help at any time, if your income and resources change. If you don’t qualify for Extra Help, you can still enroll in a Medicare Part D plan to get some coverage for your prescription Medications. However, you’ll have to pay any premiums, deductibles, and any copayment or coinsurance for your prescription drugs.

Are there other ways to lower my drug costs?

If you don’t qualify for Extra Help, there may be other ways for you to save on drug costs. Some options to look into are:
• Your state may offer some help with drug costs. Check State Pharmaceutical Assistance Programs (SPAPs) to see if you qualify. Many states offer some type of coverage to help people with Medicare pay various plan costs. You may be required to get a Part D plan, but then the program will help with the drug costs that your Part D plan doesn’t cover.
• The company that makes your drug may offer some help paying for it. Many major drug manufacturers offer PAPs, or Pharmaceutical Assistance Programs, for people with Medicare drug coverage.
• Check with your doctor if you can replace your brand-name prescription with a generic drug, or a cheaper brand-name drug.
• Shop Medicare Advantage plans in your area. Many Medicare Advantage plans bundle Part D drug coverage into their plans, covering varying costs from your prescriptions. Many of these plans can even offer $0 premiums.