Medicare Extra Help for drug costs: who qualifies and how to apply

Updated 2026-10-19 · Reviewed for accuracy by the EKO Labs team. Educational only; not medical advice.

Medicare Extra Help is a program that lowers the cost of Medicare drug coverage (Part D) for people with limited income and resources. Many people who qualify never apply, so it is worth checking. This guide summarizes what Medicare.gov says about Extra Help, the rules in federal regulation, and where to get free help applying. It is general information, not medical, legal or insurance advice.

What is Extra Help?

According to Medicare.gov, "Extra Help" is a Medicare program that helps people with limited income and resources pay Medicare drug coverage (Part D) premiums, deductibles, coinsurance and other costs. You also do not have to pay a Part D late enrollment penalty while you get Extra Help. The federal rules call this the low-income subsidy (42 CFR 423.773). Extra Help is not available in Puerto Rico, the U.S. Virgin Islands, Guam, the Northern Mariana Islands or American Samoa, but other programs may exist there, so call your State Medical Assistance (Medicaid) office to learn more.

Who gets Extra Help automatically?

Medicare.gov says you get Extra Help automatically if you have any of the following:

• full-benefit Medicaid coverage;
• help from your state paying your Part B premiums (a Medicare Savings Program);
• Supplemental Security Income (SSI) payments from Social Security.

You will get a notice in the mail about your Extra Help. It tells you things like how much you will pay and your new Medicare drug plan, if you do not have one already.

Who should apply?

If you do not get Extra Help automatically, you can apply. In most cases you must have income and resources below certain limits, and the limits may go up each year. The federal rule sets the income test at below 150 percent of the federal poverty level for your family size, plus a resource limit (42 CFR 423.773). Medicare.gov lists these limits for 2026:

• Individual: income limit $23,940 and resource limit $18,090.
• Married couple: income limit $32,460 and resource limit $36,100.

Medicare.gov has separate pages on what counts as income and as resources, and notes that the limits are different if you live in Alaska or Hawaii. Even if you do not qualify now, you can reapply at any time if your income or resources change.

How to apply

Medicare.gov points to the Extra Help application on the Social Security Administration website. You can also contact your local State Health Insurance Assistance Program (SHIP) for free help applying; SHIPs are not connected to any insurance company or health plan. You can apply for Extra Help and for Medicare Savings Programs at the same time. These are state programs that help with other Medicare costs. According to Medicare.gov, Social Security will send information to your state to start a Medicare Savings Program application unless you tell them not to on the Extra Help application.

What you pay with Extra Help in 2027

Medicare.gov lists these amounts for 2027:

• plan deductible: $0;
• prescriptions filled at a participating pharmacy: up to $5.80 for each generic drug and up to $14.40 for each brand-name drug;
• once your total drug costs (including certain payments made on your behalf, such as through the Extra Help program) reach $2,400, you pay $0 for each covered drug;
• if you also have full Medicaid coverage and are in the Qualified Medicare Beneficiary (QMB) program, you pay no more than $4.90 for each covered drug.

Your own amounts depend on your level of Extra Help, so use the notice you receive or call 1-800-MEDICARE (1-800-633-4227; TTY 1-877-486-2048) to confirm them.

What happens after you qualify

• If you do not have a Medicare drug plan, Medicare automatically enrolls you in one so you can get the savings. You will get a notice about the new plan, and you can pick a different plan if you want.
• You keep getting Extra Help for the rest of the calendar year, even if your income changes during the year.
• If you still meet the limits for next year, you keep Extra Help. Medicare says it mails a notice only if you no longer qualify or you are moved to a different plan. If you do not get a notice, you keep Extra Help and the same plan.
• If you have Medicaid or get Extra Help, you may be able to change your drug coverage once per month, while most people can switch plans only at certain times of the year.

If you think you are paying the wrong amount

Medicare.gov suggests these steps if you qualify for Extra Help but think you are paying the wrong amount:

• contact your drug plan; it may ask for proof that you get Extra Help;
• tell your plan how many days of medication you have left, so the plan and Medicare can try to fix the problem before you run out;
• call 1-800-MEDICARE, who can tell you your level of Extra Help and help you get your costs corrected.

Temporary coverage while you wait: LI NET

Medicare's Limited Income Newly Eligible Transition (LI NET) program gives temporary Part D drug coverage to people who qualify for Extra Help or Medicaid but are not yet enrolled in a Medicare drug plan. If you paid for covered Part D drugs after you qualified for LI NET, you may be able to get some money back, so keep your receipts. The LI NET phone line is 1-800-783-1307 (TTY 711), open 8 a.m. to 7 p.m. Eastern time.

Other ways Medicare suggests to lower drug costs

• Compare Medicare drug plans for one with lower drug costs.
• Ask your doctor whether a generic drug, or a less expensive brand-name drug, is an option.
• Check costs at mail-order pharmacies, which can sometimes be cheaper.
• Learn whether the Medicare Prescription Payment Plan could help you spread out costs.

Our guides on comparing Medicare drug plans, drug formularies and the Medicare Prescription Payment Plan explain these topics in more detail.

EKO Labs does not sell insurance, does not determine eligibility and does not recommend plans. Our team can help you prepare questions in Portuguese or English by phone. EKO Labs does not publish dosing instructions.

Sources: Medicare.gov, "Help with drug costs" (medicare.gov/basics/costs/help/drug-costs); 42 CFR 423.773, "Requirements for eligibility" (law.cornell.edu/cfr/text/42/423.773), consulted October 2026. Amounts and limits change; confirm them on Medicare.gov. This guide is general information, not medical, legal or insurance advice.