Extra Help with Medicare: What It Is, Who Qualifies, and How to Apply

What Is Extra Help with Medicare?

Extra Help is a Medicare program that helps people with limited income and resources pay for Medicare Part D prescription drug costs. It can cover monthly premiums, annual deductibles, and co-payments or co-insurance. The program is formally known as the Low-Income Subsidy, or LIS, and it is paid for by the federal government. If you have Medicare and struggle to afford your medications, Extra Help can significantly reduce what you pay out of pocket.

Who Qualifies for Extra Help with Medicare

Qualification depends on your income, resources, and whether you live in one of the 50 states, the District of Columbia, or certain U.S. territories. You may qualify if you meet the financial limits set each year and if you are already enrolled in Medicare Part A and/or Part B. Citizenship or lawful presence requirements also apply. Certain people automatically qualify, including those who receive Medicaid, get Supplemental Security Income, or are enrolled in a Medicare Savings Program.

Income and Resource Limits

The Social Security Administration uses strict income and asset limits to determine eligibility. Income includes wages, Social Security benefits, pensions, and other regular payments. Resources include bank accounts, stocks, bonds, and property you do not live in. The limits change each year, so it is important to check the current figures before applying.

What Extra Help With Medicare Covers

If you receive Extra Help, your Medicare Part D plan will typically cover more of your prescription drug costs. The help can reduce or eliminate the coverage gap, also known as the donut hole, and lower your annual deductible. You may also pay a reduced monthly premium, though some plans charge no premium at all for people who qualify. The level of help you receive depends on your income and resources.

• Reduced or $0 monthly Part D premiums
• Reduced or $0 annual deductible
• Lower co-payments or co-insurance for covered drugs
• No coverage gap liability in most cases
• No late enrollment penalty for certain creditable coverage gaps

How to Apply for Extra Help with Medicare

You can apply for Extra Help online through the Social Security Administration website, by calling Social Security directly, or by visiting your local Social Security office. You will need to provide proof of income, resources, and Medicare enrollment. If you already receive Medicaid or SSI, you may be automatically enrolled in the program, but you should still confirm your status with Medicare or your state Medicaid agency.

Medicare Savings Programs and Extra Help

Extra Help is separate from Medicare Savings Programs, which help pay for Medicare Part A and Part B premiums and other costs. Some people qualify for both. Medicare Savings Programs are run by states, while Extra Help for prescription drugs is a federal program. If you are unsure which programs you qualify for, a State Health Insurance Assistance Program, or SHIP counselor, can help you sort through your options.

Staying Covered and Reapplying

Extra Help is not a one-time benefit. You must reapply each year to keep your subsidy. Your income or resources may change, which can affect your eligibility or the level of help you receive. If you move to a new state or change your Medicare plan, you should update your information with Social Security. Keeping your contact information current helps ensure you continue to get the assistance you need without interruption.

Other Programs That Provide Extra Help with Medicare

Beyond Extra Help and Medicare Savings Programs, several other programs can lower your Medicare costs. These include Medicare Advantage plans with $0 premiums, state pharmaceutical assistance programs, and manufacturer discount cards. Some nonprofits and community organizations also offer help with Medicare premiums, drug costs, and enrollment decisions. If your income is just above the Extra Help limits, these other resources may still make Medicare more affordable.