Many seniors in the U.S. struggle to afford their medications-even with Medicare. The cost of insulin, heart medications, or arthritis drugs can eat up a fixed income. But there’s a federal program designed specifically to help: the Extra Help Program, also known as the Part D Low-Income Subsidy (LIS). Since January 2024, this program has become even more powerful thanks to the Inflation Reduction Act. Now, everyone who qualifies gets full benefits-no more partial help. If you or a loved one is over 65, on Medicare, and has limited income, you could be saving thousands each year on prescriptions.
Who Exactly Qualifies for Extra Help?
You don’t need to be broke to qualify. The income and resource limits are set each year based on the Federal Poverty Level. In 2025, if you’re single, your annual income must be $23,475 or less. If you’re married and living with your spouse, your combined income must be $31,725 or less. These numbers include your adjusted gross income plus any tax-exempt interest, like from municipal bonds. But income isn’t the only factor. You also have to meet resource limits. Resources are things you own that can be turned into cash: savings accounts, stocks, bonds, mutual funds, and real estate you don’t live in. For individuals, that total can’t exceed $17,600. For couples, it’s $35,130. Here’s what doesn’t count:- Your primary home
- One car
- Household items and personal belongings
- Up to $1,500 set aside for burial expenses
Many people think they’re too rich to qualify because they have a small savings account or a piece of land they don’t live on. But if those assets are under the limit-and your income is too-you might still qualify. Even if you’re slightly over, some income is excluded: the first $20 of monthly income, the first $65 of earned income, and half of anything you earn after that. Income from a child in the military doesn’t count either.
How Do You Get Extra Help? Three Ways
You don’t always have to apply. In fact, about 12.5 million people get Extra Help automatically. You’re automatically enrolled if you:- Have both Medicare and Medicaid
- Get Supplemental Security Income (SSI)
- Enrolled in a Medicare Savings Program (MSP)
- Receive state help paying your Medicare Part B premium
If you’re not automatically enrolled, you can apply in three ways:
- Online: Go to ssa.gov/extrahelp and fill out the form. It takes about 15 minutes.
- By phone: Call Social Security at 1-800-772-1213 (TTY: 1-800-325-0778). Hours are 8 a.m. to 5:30 p.m. Monday through Friday.
- In person: Visit your local Social Security office. Bring your Medicare card, proof of income (like your last tax return or pay stubs), and bank statements showing your assets.
You’ll need to prove your income and resources. Common mistakes? People include income that doesn’t count, misvalue their assets, or forget to sign the form. About 22% of applications get rejected for incomplete paperwork.
What Does Extra Help Actually Cover?
The benefits are substantial. Once you’re approved, you’ll see immediate savings:- No Part D premiums: You pay $0 for any Medicare Part D plan that offers a $0 premium-which most do in every state.
- No deductible: The standard $595 deductible is completely waived.
- Low copays: If your income is at or below 100% of the Federal Poverty Level, you pay up to $1.60 for generics and $4.80 for brand-name drugs. If your income is between 100% and 150%, you pay up to $4.90 for generics and $12.15 for brand-name drugs.
- No late enrollment penalty: Even if you didn’t sign up for Part D when you first became eligible, you won’t be charged extra.
- Insulin capped at $35/month: Since 2025, all Extra Help beneficiaries pay no more than $35 for a month’s supply of insulin.
- Free vaccines: Flu, pneumonia, and shingles shots cost you $0.
On average, Extra Help cuts out-of-pocket drug costs by 83%. For someone taking five or more prescriptions monthly, that can mean saving $5,000 to $7,000 a year.
What If You’re Denied? Don’t Give Up
About 28% of applicants are initially denied. But many of those denials are mistakes. If you’re turned down, you have 60 days to appeal. Call Social Security and ask for a reconsideration. Bring updated documents: a new tax return, a letter from your bank showing lower balances, or proof of a recent medical expense that reduced your savings. Also, don’t assume you’re ineligible just because your income is a little over the limit. Some people with pensions, small rental income, or part-time work still qualify after exclusions are applied. Social Security has a new automated screening tool on their website that checks your records against other government databases. It might find you’re eligible even if you didn’t realize it.Why So Many Seniors Miss Out
Despite the program’s benefits, the Government Accountability Office found that 4.3 million eligible seniors aren’t enrolled. That’s $26.8 billion in free assistance going unused every year. Why? Many seniors don’t know about it. Others think it’s too complicated. Some believe they make too much money. A few are afraid of applying because they think it’s a welfare program and worry about stigma. The truth? Extra Help isn’t welfare. It’s a Medicare benefit you’ve paid into. You’re not taking from others-you’re using a program designed to help you afford the medications you need to stay healthy.
What Happens After You Apply?
If you’re approved, you’ll get a letter from Social Security within 3 to 6 weeks. Most approvals come within 21 days. Your Part D plan will be automatically updated. If you’re not already enrolled in a Part D plan, you’ll be signed up for one with a $0 premium. You don’t have to pick it-Social Security will do it for you. Your copays will be lowered at the pharmacy right away. You won’t have to pay the full price anymore. If you’ve been paying full price for months, you may even get a refund for overpayments made since your eligibility date.Is Extra Help Worth It?
Absolutely. For a senior on a fixed income, the difference between paying $12 for a brand-name blood pressure pill and $4.90 can mean choosing between buying medicine or paying the electric bill. The program doesn’t just help with costs-it helps people stay healthy, avoid hospital visits, and live independently longer. The data shows it works. In states like Mississippi, nearly half of all Medicare Part D enrollees get Extra Help. In Minnesota, it’s lower-but that doesn’t mean fewer people qualify. It means fewer people applied. If you’re over 65, on Medicare, and spending more than $50 a month on prescriptions, you should apply. Even if you think you’re just above the income limit, apply anyway. The system is built to help people like you. You’ve earned it.Need Help Applying?
Many local Area Agencies on Aging, senior centers, and nonprofit organizations offer free help filling out the Extra Help application. Call 211 or visit your state’s aging services website. You can also ask your pharmacist-they often know which seniors qualify and can point you to resources. Don’t wait until your next prescription bill arrives. Apply now. The savings start as soon as you’re approved.Do I have to reapply for Extra Help every year?
No. Once you’re approved, your eligibility is automatically reviewed each year. Social Security checks your income and resources against the latest limits. If you still qualify, you’ll keep your benefits. You only need to reapply if your income or assets change significantly-like if you inherit money or sell a property. You’ll be notified if a review is needed.
Can I get Extra Help if I’m not on Medicaid?
Yes. You don’t need Medicaid to qualify. Extra Help is based on your own income and resources, not on whether you have other government assistance. Many seniors who don’t qualify for Medicaid still get Extra Help because their income is low but they don’t meet Medicaid’s stricter asset rules.
What if I’m still working part-time? Can I qualify?
Yes. Part-time income is counted, but only after exclusions. The first $20 of any monthly income is ignored. The first $65 of earned income is ignored, and then half of what’s left is excluded. So if you earn $1,000 a month from a part-time job, only $467 counts toward your income limit. That means many working seniors still qualify.
Does Extra Help cover all my medications?
Extra Help doesn’t cover every drug, but it covers all drugs on your Medicare Part D plan’s formulary. Most plans include at least 90% of commonly prescribed medications. If a drug you need isn’t covered, you can ask your doctor for a generic alternative or request an exception from your plan. Extra Help doesn’t change the formulary, but it makes the covered drugs much more affordable.
Can I switch my Part D plan after getting Extra Help?
Yes. In fact, you can change your Part D plan once a year during the Annual Enrollment Period (October 15 to December 7). But if you’re on Extra Help, you can switch plans at any time during the year-no restrictions. That means if a new plan offers better coverage for your medications, you can switch right away.
Andrea Jones
Wow, this is the kind of info that actually saves lives. I told my neighbor Mrs. Rivera last week she was throwing away $400 a month on insulin - she didn’t even know this program existed. Now she’s got her application in. People need to stop assuming they’re ‘too rich’ - the exclusions are wild. That $65 earned income buffer? Game changer for part-timers.
Evelyn Salazar Garcia
Government handout. Why should I pay for your meds?
Rosy Wilkens
Let me be clear - this isn’t ‘help,’ it’s systemic exploitation. The government is quietly redistributing wealth under the guise of ‘Medicare benefits.’ You think your Social Security taxes bought you this? No. It’s a trap. They’ll use your enrollment data to track you, then raise your premiums next year. They’ve been doing this since 2018 - watch the fine print. And don’t get me started on how they auto-enroll you into plans that don’t cover your drugs. It’s a bait-and-switch with a smile.