Prescription drugs can eat a huge share of a fixed income, and many people on Medicare who qualify for help never ask for it. Extra Help is a federal program that can shrink what you pay for Part D premiums, deductibles and copays, sometimes dramatically. If your income and savings are limited, this might be the single biggest drug-cost cut available to you.
Quick answer: Extra Help (officially the Part D Low-Income Subsidy) is a federal program that lowers what you pay for Medicare prescription drug coverage. You apply through the Social Security Administration (SSA) at ssa.gov or by phone, and you qualify based on limited income and resources. Many people who get Medicare Savings Program help or Medicaid are enrolled automatically.
What Extra Help Medicare actually is
Medicare Part D is the prescription drug part of Medicare. It comes with a monthly premium, often a deductible, and copays or coinsurance when you fill a prescription. Extra Help reduces those costs for people with limited income and resources.
You may see it called the Low-Income Subsidy, or LIS. Same program, different name. It is run jointly by SSA and Medicare, and it is not a loan. You do not pay it back.
What Extra Help can cover
The exact amounts depend on your income level, your plan and the year, so treat the table below as a general picture and confirm current figures with Medicare or SSA.
| Cost | Without Extra Help | With Extra Help |
|---|---|---|
| Monthly Part D premium | Varies by plan, often $0 to $50+ | Reduced or $0 for many benchmark plans, depending on your level |
| Annual deductible | Often several hundred dollars | Reduced or eliminated depending on your level |
| Copays at the pharmacy | Varies by drug tier | Capped at low set amounts that change each year |
| Coverage gap and catastrophic costs | Higher out-of-pocket exposure | Little or no cost-sharing at the highest spending levels |
| Late enrollment penalty | Can add to premiums for life | Generally waived for people with Extra Help |
Savings vary widely. Some people save hundreds of dollars a year, and some save well over a thousand, depending on how many medications they take and how expensive they are. No one can promise your exact number, but the potential is real.
If you qualify for Extra Help and never apply, you are leaving money on the pharmacy counter.
Who qualifies
Eligibility rests on two things: income and resources. Resources means things like savings, checking accounts, stocks and bonds. The limits are set by law and adjusted each year, so check current numbers at ssa.gov or Medicare.gov before you decide you earn too much.
Basic requirements
- You are enrolled in Medicare Part A and/or Part B (or eligible for it).
- You live in the U.S. (rules differ slightly for territories).
- Your income and resources fall under the current limits.
What usually does not count as a resource
The home you live in generally does not count. Neither does a personal vehicle, and certain other items are typically excluded as well. Do not rule yourself out just because you own a house or a car, and ask SSA how your situation is counted.
Automatic qualification
Some people get Extra Help without applying. You are generally deemed eligible if you have both Medicare and full Medicaid coverage, if you get help from a state Medicare Savings Program, or if you receive Supplemental Security Income (SSI). If you are in one of these groups, you should receive a notice from Medicare or SSA. If you are unsure, call and ask.
How to apply through SSA, step by step
The application is free. Do not pay anyone to file it for you.
- Gather your information. You will need your Social Security number, Medicare information, and rough figures for your income and resources: bank balances, retirement account balances, pension and Social Security amounts, and any other income.
- Choose how to apply. You can apply online at ssa.gov, by calling SSA, or by visiting a local Social Security office. Ask your local office or SSA about paper options if you prefer them.
- Answer the questions honestly. Estimates are fine where you do not have exact numbers, but be as accurate as you can. Mistakes can cause delays.
- Submit and keep proof. Save your confirmation number, or keep a copy of anything you mail. Write down the date you applied.
- Watch your mail. SSA may ask for more information. Respond fast, because missed deadlines are a common reason people lose out.
- Tell your Part D plan. Once approved, your plan should adjust your costs. If your pharmacy still charges the old price, ask them and your plan to apply your Extra Help status.
Money move: Before you apply, call your local State Health Insurance Assistance Program (SHIP) for a free counseling session. Counselors are trained, unbiased and do not sell plans. They can check which programs you qualify for and help with the paperwork. Find yours through shiphelp.acl.gov or by calling 1-800-MEDICARE.
Combine Extra Help with Medicare Savings Programs
This is where many households leave money behind. Medicare Savings Programs (MSPs) are run by your state’s Medicaid office. They can pay some or all of your Medicare Part B premium, and in some cases other cost-sharing too. Extra Help covers drug costs, while MSPs cover premiums and other Medicare costs.
The two work together. If you qualify for an MSP, you are generally treated as eligible for Extra Help as well. If you apply for Extra Help and your income is low, it is worth checking MSP eligibility at the same time. Our guide to Medicare Savings Programs and help with Part B premiums walks through each level.
| Program | What it helps with | Who runs it |
|---|---|---|
| Extra Help (LIS) | Part D drug premiums, deductibles and copays | SSA and Medicare |
| Medicare Savings Programs | Part B premiums, and sometimes more | Your state Medicaid agency |
| Medicaid (full) | Broader health coverage, often includes drug coverage | Your state Medicaid agency |
| SHIP counseling | Free, unbiased help comparing plans and programs | State SHIP offices |
Apply for Extra Help and your state’s savings program together, because one approval can open the other door.
What to do after you are approved
Check that your pharmacy applies it
Sometimes the system is slow to update. If your copays look too high after approval, ask the pharmacist to confirm your Extra Help status with your plan. You can also call the number on your plan card and ask them to update it.
Review your plan every year
Extra Help does not lock you into a plan, and not every plan is equally good for you. During the annual open enrollment period (typically in the fall), compare plans using the Medicare Plan Finder on Medicare.gov or with a SHIP counselor. Check that your specific drugs are covered and your pharmacy is in the network.
Know the special enrollment option
People with Extra Help generally get more flexibility to change Part D plans outside the usual window. Rules change, so confirm the current options with Medicare before you switch.
Stack other savings on top
Extra Help is the big one, but it is not the only lever. Once you are enrolled, try these.
- Ask about generics. Many brand-name drugs have lower-cost generic versions. Our guide on how to lower prescription costs covers 12 more ways.
- Use a 90-day supply. Many plans charge less per month for mail-order or 90-day fills. Ask your plan.
- Compare pharmacies. Plans often have preferred pharmacies with lower copays.
- Look at the rest of your bills. A tighter budget on drugs can free up room elsewhere. Our help paying bills hub lists programs for utilities, phone service and more.
Also keep an eye on other health costs. Dental care is not covered by original Medicare, so see our upcoming guide on how to lower dental bills. And if you are ever unsure where to go for care, our piece on urgent care vs ER cost can help you avoid a much bigger bill.
Common mistakes that cost people Extra Help
- Assuming you earn too much. Limits are adjusted and some income may be treated differently than you expect. Apply and let SSA decide.
- Assuming your house disqualifies you. Your primary home generally does not count as a resource.
- Ignoring mail from SSA or Medicare. Requests for information have deadlines.
- Falling for scams. Applying is free. Beware of anyone who calls you, asks for payment or asks for your Medicare number to “sign you up.” Only apply through SSA or Medicare directly.
- Never reviewing your plan. A better-matched plan can lower your costs even more.
If you run into a denial for a drug or service later, see our guide to appealing an insurance claim denial. And for the bigger picture on medical costs, start with our hub on how to negotiate medical bills. You can also browse everything in the Medical Bills category.
Bill Reduction Institute is an independent publication and is not part of Medicare, SSA or any insurer. We may earn referral fees from partners, which never changes our advice. Program rules and dollar limits change, so confirm current details with SSA, Medicare.gov or your state’s SHIP.
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Key takeaways
- Extra Help (the Part D Low-Income Subsidy) can reduce your drug premiums, deductibles and copays.
- You apply for free through SSA, and many people on Medicaid, SSI or a Medicare Savings Program qualify automatically.
- Your home and car generally do not count toward the resource limit, so do not rule yourself out too fast.
- Apply for Medicare Savings Programs at the same time to also lower Part B premiums.
- A free SHIP counselor can check your eligibility and compare plans without selling you anything.
- Review your Part D plan each year and confirm limits with SSA or Medicare, since amounts change.
Frequently asked questions
Is Extra Help the same as Medicare Savings Programs?
No. Extra Help (also called the Part D Low-Income Subsidy) lowers prescription drug costs. Medicare Savings Programs are run by your state and help pay Medicare premiums, and sometimes other costs. They are separate programs, but qualifying for one can automatically qualify you for the other, so it often makes sense to apply for both.
Do I have to reapply for Extra Help every year?
Most people do not reapply every year, but Medicare and the Social Security Administration (SSA) do review eligibility periodically, and you may be asked to confirm your information. Watch your mail for notices and respond quickly. If your income or resources change, report it. Confirm current renewal rules with SSA or Medicare.
What if I am denied Extra Help?
You can ask for a redetermination or appeal, and you can reapply any time your situation changes, such as lower income or higher medical costs. Ask SSA to explain exactly which income or resource figure caused the denial. A free State Health Insurance Assistance Program (SHIP) counselor can help you review the decision.
Can I get Extra Help if I own a home?
Often yes. The resource test generally does not count the home you live in, and certain items like a personal vehicle are typically excluded too. Counted resources usually include things like bank accounts, stocks and bonds. Rules and limits change, so check the current details with SSA.
Do I need to switch Part D plans if I get Extra Help?
Not always, but it is worth checking. Extra Help applies to your Part D plan’s costs, and some plans cover your specific drugs better or charge you less than others. Review your plan’s drug list (formulary) and pharmacy network, and ask a SHIP counselor or call 1-800-MEDICARE to compare options for your situation.