Extra Help (Low Income Subsidy) for Medicare Part D
A federal program that can save eligible Medicare beneficiaries over $5,000 a year on prescription drug costs. Here's how to know if you qualify.
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What Is Extra Help?
Extra Help — officially called the Part D Low-Income Subsidy, or LIS — is a federal program that helps people with limited income and resources pay for Medicare prescription drug costs. It’s administered by the Social Security Administration in partnership with Medicare.
✓ Average value: The Social Security Administration estimates Extra Help is worth more than $5,000 per year to eligible beneficiaries — covering some or all of your Part D premium, deductible, and copays.
Not sure if you qualify? Let us check for you — free.
What Does Extra Help Cover?
If you qualify, Extra Help reduces what you pay at the pharmacy and toward your monthly Part D premium. You still need to be enrolled in a Medicare Part D plan — Extra Help reduces your costs within that plan, it doesn’t replace it.
| 2026 Income Level | Max Copay per Fill |
|---|---|
| At or below 100% of Federal Poverty Level | No more than $4.90 |
| Above 100% up to 150% of Federal Poverty Level | No more than $12.65 |
Many beneficiaries with full Extra Help pay $0 in premiums and little to nothing in deductibles, depending on the benchmark plan available in their area.
2026 Income & Resource Limits
Eligibility is based on two separate tests — your income and your resources (assets). You generally need to qualify under both.
Income Test (150% FPL)
- Individual: approximately $23,475–$23,940/year
- Married couple: approximately $31,725–$32,460/year
Resource (Asset) Test
- Individual: $16,590
- Married couple: $33,100
⚠ Income and resource limits are updated annually and can vary slightly by source and state. The figures above are general 2026 guidelines — NISONA can check your specific situation against the most current thresholds at no cost.
What Counts as a Resource?
✓ Counted
- Bank accounts (checking and savings)
- Stocks and bonds
- Certificates of deposit (CDs)
- Retirement accounts
- Real estate beyond your primary home
✗ Not Counted
- Your primary home
- One vehicle
- Personal belongings and jewelry
- Life insurance policies (below a set value)
- Up to $1,500 per person set aside for burial expenses
Do I Automatically Qualify?
Yes — if you already participate in certain other programs, you’re automatically enrolled in Extra Help with no separate application required.
-
✓
You have full Medicaid coverage -
✓
You participate in a Medicare Savings Program (QMB, SLMB, or QI) -
✓
You receive Supplemental Security Income (SSI) benefits
Important: Even if you automatically qualify for Extra Help, you must still be enrolled in a Medicare Part D plan to use the benefit. If you qualify but aren’t enrolled in a plan, Medicare can automatically enroll you in a benchmark plan — but you may want to compare your options first to make sure your specific medications are covered.
How to Apply for Extra Help
If you don’t automatically qualify, you can apply directly with the Social Security Administration.
🌐 Online
Apply at ssa.gov/medicare/part-d
📞 By Phone
Call Social Security at 1-800-772-1213
TTY: 1-800-325-0778
🏠 In Person
Visit your local Social Security office
📝 Combined Application
Many state Medicaid offices accept one application for both Medicaid and Extra Help together
Documents You May Need
- Proof of income (Social Security award letter, pay stubs)
- Proof of Medicare enrollment
- Proof of identity and residency
- A list of your resources/assets
Many people who qualify never apply because they assume they earn too much. It only takes a few minutes to check.
Frequently Asked Questions
Do I still need a Part D plan if I get Extra Help?
Yes. Extra Help reduces what you pay within a Medicare Part D plan — it doesn’t replace the need to be enrolled in one. If you qualify but aren’t enrolled, Medicare can auto-enroll you in a benchmark plan.
Does Extra Help cover every medication?
Extra Help reduces your cost for any drug covered under your Part D plan’s formulary (its list of covered drugs). It’s worth reviewing whether your specific medications are on the formulary when choosing a plan.
If I qualify for Medicaid, do I automatically get Extra Help too?
Yes. If you qualify for Medicaid, you automatically qualify for Extra Help as well, with no separate application needed.
Will I need to reapply every year?
The Social Security Administration reviews eligibility periodically, typically using tax return data. If your income or resources change significantly, you may need to provide updated information or reapply.
How does Extra Help interact with the new $2,100 out-of-pocket cap?
Extra Help and the annual Part D out-of-pocket cap work together — Extra Help lowers your costs along the way, while the $2,100 cap protects everyone with Part D from catastrophic spending, regardless of income.
Official Resources
We encourage you to review these official government resources as part of your decision.
⚠ Medicare Disclaimer: This information is for educational purposes only and is not a complete description of benefits. Income and resource limits are updated annually and may vary by source. Contact a licensed Medicare agent or the Social Security Administration for your specific eligibility. NISONA is an independent insurance agency and is not affiliated with Medicare or the Social Security Administration.
NISONA — Get Someone on Your Side
Many people who qualify for Extra Help never apply, simply because they assume their income is too high. Let us take a quick look at your situation — it costs nothing, and it could save you thousands every year.
Our service is completely free and 100% unbiased. Discover the difference of having NISONA on your side.
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