Medicare Extra Help: The Part D Subsidy That Saves Thousands on Drug Costs

Extra Help is a federal program that provides substantial assistance with Medicare Part D prescription drug costs for people with limited income and assets. Also called the Low Income Subsidy or LIS, it can reduce or eliminate Part D premiums, eliminate the annual deductible, and cap drug copays at levels that make medications genuinely affordable. In 2025, people who qualify for Extra Help pay no more than $4.60 for generic drugs and $11.20 for brand-name drugs per fill. Despite these benefits, roughly 2 million eligible people do not receive Extra Help because they never apply.

Bryce's Take

This is a benefit I actively help clients apply for. The application is not complicated, but people do not know it exists or assume they will not qualify. I have had clients at 140% of the federal poverty level who were paying full Part D cost-sharing because nobody ever mentioned Extra Help to them. If you are on a fixed income and drug costs are a burden, this is the first conversation to have.

What Extra Help covers

Extra Help assistance varies by income level. Full Extra Help eliminates the Part D monthly premium (the plan pays it), eliminates the annual Part D deductible, and caps copays at $4.60 for generics and $11.20 for brand-name drugs in 2025. Partial Extra Help provides reduced premium assistance and lower cost-sharing thresholds. In either case, the benefit is substantial for people taking multiple medications, particularly brand-name or specialty drugs that would otherwise cost hundreds per month.

Who qualifies for Extra Help

Eligibility is based on income and assets. For 2025, the income limit for full Extra Help is approximately 135% of the federal poverty level, which is about $20,385 annually for a single person and $27,465 for a couple. Partial Extra Help extends to approximately 150% FPL, which is about $22,590 for an individual. Asset limits also apply: in 2025, asset limits are $17,220 for a single person and $34,360 for a couple (certain assets are excluded, including your home, one car, and life insurance up to certain values). These thresholds are adjusted annually.

Automatic eligibility: who qualifies without applying

Some people are automatically enrolled in Extra Help without needing to apply. If you qualify for Medicaid, receive Supplemental Security Income (SSI), or participate in a Medicare Savings Program (QMB, SLMB, or QI), you are automatically eligible for Extra Help. Social Security notifies these individuals and automatically enrolls them in a Part D plan if they are not already enrolled in one. If you receive any of these programs, verify your Extra Help status rather than assuming you are receiving all the benefits you are entitled to.

How to apply for Extra Help

People who do not automatically qualify must apply separately. Applications can be submitted through Social Security at ssa.gov/extrahelp, by calling Social Security at 1-800-772-1213, by visiting a local Social Security office, or through your state Medicaid office. The application is straightforward and typically takes 15 to 30 minutes. Income and asset documentation may be requested. Processing takes several weeks; if approved, coverage can be retroactive to the month of application in some circumstances.

What happens after you qualify

Once you qualify for Extra Help, Social Security notifies Medicare, which flags your record. If you are not already enrolled in a Part D plan, Medicare will auto-enroll you in a benchmark plan, a low-premium plan in your area. You can switch to any Part D plan at any time with a monthly Special Enrollment Period that Extra Help qualification provides. This monthly SEP is valuable because it lets you optimize your drug coverage year-round rather than waiting for AEP.

Extra Help and Medicare Savings Programs

If you qualify for Extra Help, you may also qualify for one of the Medicare Savings Programs that help pay Part B premiums, deductibles, and copays. The two programs have separate applications and separate eligibility criteria, but incomes that qualify for Extra Help often also qualify for at least SLMB (Specified Low-Income Medicare Beneficiary), which pays the Part B premium. Applying for both simultaneously through your state Medicaid office is the most efficient approach.

Bryce Casson

Licensed Independent Medicare Broker

Bryce Casson is an independent Medicare insurance broker who works with every major carrier. He does not represent any single insurer, which means his recommendations are based on what actually fits each client's situation, not on commissions or quotas.