Medicare Part D Extra Help (Low-Income Subsidy)

What this actually is

Extra Help wipes out your Part D premium and deductible and caps what you pay at the pharmacy counter. In 2026 that means $0 premium, $0 deductible, no more than $5.10 for a covered generic and $12.65 for a covered brand-name drug — and once your total drug costs reach $2,100 you pay $0 for covered drugs for the rest of the year. If you also have full Medicaid and QMB you pay no more than $4.90 per drug. This is a subsidy, not a loan, and there is nothing to pay back. The misunderstanding that keeps people out: the resource limits sound disqualifying but they are far higher than the Medicare Savings Program limits — $18,090 for an individual, $36,100 for a couple — and the income limits ($23,940 individual, $32,460 married) are annual, not monthly. Second thing worth knowing: applying for Extra Help also starts a Medicare Savings Program application with your state unless you tell Social Security not to, so one form can win you both. And if you have Extra Help or Medicaid you may change drug plans once a month instead of once a year.

Who qualifies, and what trips people up

You must have Medicare. Many people get Extra Help automatically — full Medicaid, an MSP, or SSI usually triggers it without an application. Everyone else applies to Social Security; your local SHIP will help you fill it out for free, and no one should charge you. Once approved you keep it through December 31 even if your income rises mid-year, and it renews silently — no notice means you keep it. If you were denied before and your income or resources changed, you can reapply at any time. If you qualify but the pharmacy is charging you full price, call 1-800-MEDICARE (1-800-633-4227) — and if you qualify for Extra Help or Medicaid but are not yet in a drug plan, the LI NET program at 1-800-783-1307 gives temporary Part D coverage and can reimburse drugs you already paid for, so keep your receipts.