Medicare Extra Help, also called the Low-Income Subsidy (LIS), is a federal program that reduces or eliminates Part D prescription drug costs for people with limited income and resources. In 2025, the income limit is $23,475 per year for an individual and $31,725 per year for a married couple living together. If your income falls at or below these thresholds and your assets are within the resource limits, you may qualify for significant savings on drug premiums, deductibles, and copays. Use our free benefits screener to check your eligibility in minutes.
What Is Medicare Extra Help?
Medicare Extra Help is a subsidy program run by the Social Security Administration (SSA) that helps people with Medicare Part D afford their prescription drugs. It covers:
- Monthly Part D plan premiums (up to a benchmark amount set by CMS)
- Annual deductibles
- Copayments and coinsurance for covered drugs
- The Part D late enrollment penalty
Starting in 2024, the program eliminated the distinction between "full" and "partial" Extra Help. Everyone who qualifies now receives the same full benefit level, which simplified eligibility significantly.
2025 Income Limits for Medicare Extra Help
Income eligibility is based on roughly 150% of the Federal Poverty Level (FPL). The thresholds below apply to the continental United States. Alaska and Hawaii have slightly higher limits.
| Household Size | Annual Income Limit | Monthly Income Limit |
|---|
| Individual | $23,475 | approximately $1,956 |
| Married couple (living together) | $31,725 | approximately $2,644 |
What counts as income: Social Security benefits, wages, pension payments, rental income, and most other regular income sources. Some income is excluded, including food assistance (SNAP), housing assistance, and certain other government benefits.
If your income is higher: You may still qualify if you have certain allowable deductions, live in Alaska or Hawaii, or provide financial support to other household members who live with you. The SSA calculates income after applying these deductions, so it is worth applying even if your income appears to be slightly over the limit.
2025 Asset (Resource) Limits
In addition to income, you must have assets below the resource limits. These are sometimes called "countable resources."
| Household Size | Resource Limit |
|---|
| Individual | $17,600 |
| Married couple (living together) | $35,130 |
What counts as a resource:
- Checking and savings accounts
- Stocks, bonds, and mutual funds
- IRAs and other retirement accounts
- Cash on hand
- Real estate other than your primary home
What does NOT count as a resource:
- Your primary home
- One vehicle
- Personal belongings and household goods
- Burial plots and up to $1,500 set aside for burial expenses
- Life insurance with a face value of $1,500 or less
What Extra Help Covers in 2025
Qualifying for Extra Help means your out-of-pocket prescription costs drop substantially. In 2025, the caps are:
| Drug Type | Maximum Copay |
|---|
| Generic drugs | $4.90 per prescription |
| Brand-name drugs | $12.15 per prescription |
| Premium | $0 (covered up to benchmark) |
| Deductible | $0 |
If you have full Medicaid coverage and income below 100% of the FPL, your copays are even lower.
Extra Help also removes the Part D late enrollment penalty permanently, which is important if you delayed enrolling in Part D when you first became eligible.
Automatic Qualification for Extra Help
You do not need to apply if you already receive certain other benefits. You are automatically enrolled in Extra Help if you:
- Receive full Medicaid coverage
- Receive Supplemental Security Income (SSI)
- Are enrolled in a Medicare Savings Program (MSP), including QMB, SLMB, or QI
If you fall into any of these categories, SSA will notify you by mail that you have been automatically enrolled. You can choose to keep the plan selected for you or switch to a different Part D plan during a special enrollment period.
How to Apply for Medicare Extra Help
If you are not automatically enrolled, you can apply directly through Social Security. The process is straightforward and typically takes less than 30 minutes.
Step 1: Gather Your Information
Before applying, collect the following:
- Social Security number
- Medicare card or Medicare number
- Bank account numbers and approximate balances
- Approximate values of any stocks, bonds, or IRAs
- Information about income sources (Social Security award letter, pension statements, etc.)
Step 2: Choose How to Apply
You have three options:
Online: Go to ssa.gov/extrahelp and complete the application on the SSA website. This is the fastest method and available 24 hours a day.
By phone: Call SSA at 1-800-772-1213 (TTY: 1-800-325-0778). Representatives are available Monday through Friday, 8 a.m. to 7 p.m.
In person: Visit your local Social Security office. Use the office locator at ssa.gov/locator to find the nearest location.
Step 3: Submit the Application
Submit all required information. The SSA application for Extra Help also screens you for Medicare Savings Programs in most states, which can provide additional help with Medicare Part A and Part B costs.
Step 4: Receive a Decision
SSA typically mails a decision letter within three weeks of receiving a completed application. If approved, you receive Extra Help for the remainder of the calendar year and can use the benefit immediately.
Step 5: Choose or Be Assigned a Part D Plan
If you are approved and currently enrolled in a Part D plan, the benefit applies automatically. If you are not in a Part D plan, you can join one during a Special Enrollment Period. If you do not choose a plan, CMS may assign you to one that is free or low-cost in your area.
How Extra Help Interacts with Medicare Savings Programs
Medicare Savings Programs (MSPs) are separate from Extra Help but often go hand in hand. MSPs help pay Medicare Part A and Part B premiums and cost-sharing. The four types are:
- QMB (Qualified Medicare Beneficiary): Covers Part A and Part B premiums, deductibles, and copays. Income limit is approximately 100% FPL.
- SLMB (Specified Low-Income Medicare Beneficiary): Covers Part B premiums only. Income limit is approximately 120% FPL.
- QI (Qualifying Individual): Covers Part B premiums. Income limit is approximately 135% FPL.
- QDWI (Qualified Disabled and Working Individual): Covers Part A premiums only, for people who lost premium-free Part A due to returning to work.
Enrollment in any of these automatically qualifies you for Extra Help as well. If you apply for Extra Help through SSA and do not already have an MSP, SSA will share your application information with your state Medicaid agency, which will then determine if you qualify for an MSP.
2025 vs. 2024 Changes
The most significant change happened in 2024, not 2025. The Inflation Reduction Act eliminated the partial subsidy category. Before 2024, Extra Help had two levels: a full subsidy for those with the lowest incomes and a partial subsidy for those with incomes between about 135% and 150% FPL. Since January 1, 2024, everyone who qualifies receives full Extra Help.
For 2025, the income and resource limits were updated based on annual FPL adjustments. The income limit for an individual rose slightly from $23,340 in 2024 to $23,475 in 2025. Asset limits were also adjusted upward.
If you previously received partial Extra Help, you are now receiving the full benefit automatically.
Common Reasons People Are Denied or Disenrolled
Income over the limit: If your income is just above the threshold, check whether any deductions apply (support for household members, earnings exclusions). The SSA looks at income after allowances, not gross income.
Resources over the limit: If a recent inheritance or sale of property pushed your assets above the limit, you may be ineligible for that year but could qualify again once assets are reduced.
Did not complete renewal: SSA sends annual renewal notices. If you do not respond, your Extra Help may end. Check your mail each fall for renewal forms.
Plan changed without notice: If your Part D plan is discontinued, SSA will reassign you to another plan. Make sure your address on file with SSA is current.
Frequently Asked Questions
What is the income limit for Medicare Extra Help in 2025?
The 2025 income limit is $23,475 per year for an individual and $31,725 per year for a married couple living together. These figures are based on approximately 150% of the Federal Poverty Level.
What assets are counted for Medicare Extra Help eligibility?
Countable assets include bank accounts, stocks, bonds, mutual funds, IRAs, and cash. Your home, one vehicle, personal belongings, and burial funds up to $1,500 are not counted.
Can I get Extra Help if I have Medicare Advantage instead of Original Medicare?
Extra Help applies to Part D drug coverage only. If you have a Medicare Advantage plan that includes Part D (MA-PD), Extra Help can still reduce your drug costs under that plan. The subsidy does not cover non-drug costs.
Does Social Security count income from SNAP or housing assistance toward the limit?
No. Food assistance, housing assistance, and most other government benefit payments are excluded from the income calculation for Extra Help.
How long does it take to find out if I am approved for Extra Help?
SSA typically issues a decision within three weeks of receiving a completed application. You may receive a faster decision if your application is straightforward.
Is there a limit to how many times I can apply for Extra Help?
No. You can reapply as many times as you want. If your income or assets change, you may qualify in a future year even if you were denied before.
What happens if I qualify for Extra Help but do not have a Part D plan?
You will have a Special Enrollment Period to join a Part D plan. If you do not choose one, CMS may automatically enroll you in a benchmark plan (one with no premium under Extra Help) in your area.
Does Extra Help cover the cost of the drug itself?
Extra Help reduces what you pay out of pocket in the form of copays and premiums. The drug itself is still covered under your Part D plan's formulary, subject to plan rules like prior authorization or step therapy.
Can I qualify for Extra Help and a Medicare Savings Program at the same time?
Yes. In fact, enrollment in a Medicare Savings Program automatically qualifies you for Extra Help. Both programs work together to reduce costs across Part A, Part B, and Part D.
How do I apply for Medicare Extra Help?
Apply online at ssa.gov/extrahelp, call SSA at 1-800-772-1213, or visit your local Social Security office. The application takes about 30 minutes.
If you are not sure whether you qualify for Extra Help or other Medicare cost-saving programs, our free benefits screener can check your eligibility across multiple programs at once with no obligation.
