Medicare Extra Help is a federal program that pays most or all of your Medicare Part D prescription drug costs if your income and assets fall below certain thresholds. In 2026, the program covers up to approximately $5,000 per year in drug costs for eligible beneficiaries, including premiums, deductibles, and copays. If your household income is at or below 150% of the Federal Poverty Level (FPL), you likely qualify. Here is exactly what the limits are, what counts toward them, and how to apply.
What Is Medicare Extra Help?
Medicare Extra Help, also known as the Low-Income Subsidy (LIS), is administered by the Social Security Administration (SSA) and funded through the Centers for Medicare and Medicaid Services (CMS). The program helps people with Medicare Part D pay for prescription drugs when out-of-pocket costs would otherwise be a financial burden.
Before 2024, the program had two tiers: full Extra Help and partial Extra Help. Starting in 2024, that distinction was eliminated. All beneficiaries who qualify now receive the full benefit package, regardless of where their income falls within the eligibility range.
The benefits include:
- No monthly Part D premium (for benchmark plans)
- No annual Part D deductible
- Reduced copays of $5.10 per generic drug and $12.65 per brand-name drug in 2026
- No coverage gap (the "donut hole" does not apply)
2026 Medicare Extra Help Income Limits
The income limits for Extra Help are set at 150% of the Federal Poverty Level and update each year. For 2026:
| Household Size | Annual Income Limit | Monthly Income Limit |
|---|
| 1 person (individual) | $23,475 | $1,956 |
| 2 people (married couple) | $31,725 | $2,644 |
| Each additional person | add approximately $8,250 | add approximately $688 |
Income limits are slightly higher in Alaska and Hawaii due to regional cost-of-living adjustments.
What Counts as Income
SSA counts most types of income when determining eligibility:
- Wages and self-employment earnings
- Social Security benefits (including SSDI and retirement)
- Pension and annuity payments
- Railroad Retirement benefits
- Veterans benefits (some exclusions apply)
- Net rental income
- Interest and dividends
What Does Not Count as Income
Several income sources are excluded from the calculation:
- Food assistance (SNAP benefits)
- Housing assistance payments
- Home energy assistance (LIHEAP)
- Tax refunds
- Loans you must repay
- Income earned by household members who are not on Medicare
If you are still working, SSA applies an earned income exclusion that can raise the effective threshold. This means working Medicare beneficiaries near the income limit should still apply, since their countable income may be lower than their gross earnings suggest.
2026 Medicare Extra Help Asset Limits
In addition to income, SSA looks at your resources (assets). The 2026 asset limits are approximately:
| Household | Asset Limit |
|---|
| Individual | $18,090 |
| Married couple | $36,100 |
These limits reflect the combined value of countable resources. SSA does NOT count the following:
- Your primary home (regardless of value)
- One vehicle
- Household furniture and personal belongings
- Burial plots or spaces
- Up to $1,500 per person set aside for burial expenses
- Life insurance policies with a combined face value of $1,500 or less
Countable resources include money in checking or savings accounts, certificates of deposit, stocks, bonds, mutual funds, and most retirement accounts.
Who Qualifies Automatically
You do not need to apply for Extra Help if you already receive any of the following. SSA enrolls you automatically:
- Medicaid (full Medicaid coverage, not just Medicare Savings Programs)
- Supplemental Security Income (SSI)
- Medicare Savings Program (MSP) enrollment at any level (QMB, SLMB, or QI)
If you fall into one of these categories, you should receive a purple letter from Social Security confirming your Extra Help status before the start of each calendar year. If you believe you qualify automatically but have not received this notice, call SSA at 1-800-772-1213.
How to Apply for Medicare Extra Help
If you do not receive automatic enrollment, you need to apply. The application is Form SSA-1020, and there are three ways to submit it.
Option 1: Apply Online at SSA.gov (Fastest)
- Go to ssa.gov/medicare/part-d-extra-help
- Select "Apply for Extra Help"
- Create or log in to your my Social Security account
- Complete the online form, which takes about 15 to 20 minutes
- Submit and print or save your confirmation number
The online application is available 24 hours a day and is the fastest way to get a decision.
Option 2: Apply by Phone
Call Social Security at 1-800-772-1213 (TTY: 1-800-325-0778), Monday through Friday, 8 a.m. to 7 p.m. local time. A representative will take your application over the phone. Wait times can be long, so calling early in the morning or later in the week typically means shorter holds.
Option 3: Apply In Person or by Mail
Visit your local Social Security office to apply in person, or request a paper Form SSA-1020, complete it, and mail it to your local office. You can find your local office using the SSA's office locator at ssa.gov/locator.
You can also apply through your State Medicaid office. Some states coordinate their Medicaid and Extra Help applications so that a single application covers both programs.
What Documents You Will Need
Before starting the application, gather:
- Your Medicare card (to provide your Medicare Beneficiary Identifier, or MBI)
- Social Security number or card
- Proof of income: recent pay stubs, Social Security benefit letter, pension statements, or tax returns
- Bank account balances (checking and savings)
- Investment account statements (stocks, bonds, mutual funds)
- Life insurance policy face value amounts
- Any other financial account information
You do not need to submit documents with the online application, but SSA may contact you later to verify information.
How Long Does It Take to Get a Decision?
SSA typically processes Extra Help applications within 2 to 3 weeks when submitted online or by phone. Paper applications may take longer. Once approved, SSA will send you a letter explaining your subsidy level and effective date.
If you are approved, your Extra Help benefits generally start the first day of the month after your application is approved, or earlier depending on when you enrolled in Part D.
What If You Are Denied?
If SSA denies your application, you have the right to appeal. The denial letter will explain the reason and give you 60 days to request reconsideration. You can appeal online, by phone, or in writing.
Common denial reasons include:
- Income exceeds the limit (check whether the earned income exclusion was applied correctly)
- Assets exceed the limit (verify that excluded assets like your home and vehicle were not counted)
- Missing information on the application
If your situation changes later (income drops, assets decrease), you can reapply at any time.
Extra Help and Medicare Savings Programs: What Is the Difference?
These are two separate but related programs, and many people qualify for both.
| Program | What It Covers | Who Runs It |
|---|
| Medicare Extra Help | Part D drug costs (premiums, deductibles, copays) | Social Security Administration |
| Medicare Savings Program (MSP) | Part A and Part B premiums, deductibles, and copays | State Medicaid agency |
Enrolling in a Medicare Savings Program also qualifies you for Extra Help automatically. If you think you may qualify for both, it is worth applying for the MSP through your state's Medicaid office, since that single enrollment can unlock Extra Help without a separate SSA application.
You can use the Benefits Navigator screener at benefitsusa.org/screener to check whether you may qualify for Extra Help, a Medicare Savings Program, or other assistance programs based on your income and household size.
State Pharmaceutical Assistance Programs (SPAPs)
Several states run their own prescription drug assistance programs that coordinate with Extra Help and can cover additional costs. If you live in one of these states, you may be able to stack both benefits. Contact your State Health Insurance Assistance Program (SHIP) counselor for details specific to your state. SHIP counseling is free and available in all 50 states.
Changes for 2026
A few things have changed for 2026 compared to prior years:
- Copay amounts increased slightly from 2025 levels. The 2026 standard copays are $5.10 for generics and $12.65 for brand-name drugs.
- SSA has implemented tighter eligibility verification procedures, meaning documentation may be requested more frequently during reviews.
- Income and asset limits increased modestly to reflect FPL updates.
The core structure of the program, including the full subsidy for all qualifying enrollees, remains the same as it has been since the 2024 Inflation Reduction Act changes took effect.
Frequently Asked Questions
What is the income limit for Medicare Extra Help in 2026?
The 2026 income limit is $23,475 per year for individuals and $31,725 per year for married couples. These figures represent 150% of the Federal Poverty Level. Income limits are slightly higher in Alaska and Hawaii.
Do I have to report assets to apply for Extra Help?
Yes. SSA asks about your countable resources, including bank accounts, investments, and certain other assets. Your home, one vehicle, and household belongings do not count toward the asset limit. The 2026 asset limits are approximately $18,090 for individuals and $36,100 for couples.
Can I get Extra Help if I still work?
Yes. SSA applies an earned income exclusion when calculating your income for Extra Help purposes. This means your countable income is lower than your gross wages, and working Medicare beneficiaries with income near the limit may still qualify.
Does Extra Help automatically enroll me in a Part D plan?
No. Extra Help is a subsidy that pays your Part D costs, but you still need to be enrolled in a Medicare Part D drug plan. If you qualify for Extra Help but are not in a plan, Medicare can auto-enroll you in a benchmark plan.
How long does Extra Help coverage last?
Once approved, you stay enrolled as long as your income and assets remain within the limits. SSA reviews eligibility each year, typically using tax return data. If your situation changes, you may need to reapply.
Can I apply for Extra Help and Medicaid at the same time?
Yes, and it is often worth doing. Many state Medicaid offices accept a single application for Medicaid and Extra Help together. If you qualify for Medicaid, you automatically qualify for Extra Help as well.
What drugs does Extra Help cover?
Extra Help covers any prescription drug that is on your Part D plan's formulary. The subsidy lowers your costs for those drugs, but your plan's list of covered drugs (formulary) still applies. You may want to review whether your current medications are covered when choosing or switching plans during open enrollment.
Where do I apply for Medicare Extra Help?
Apply online at ssa.gov/medicare/part-d-extra-help, by calling SSA at 1-800-772-1213, in person at a Social Security office, or through your state Medicaid office. You can also use the free screener at benefitsusa.org/screener to check your estimated eligibility before applying.
