Reminder: You may now qualify for Medicare Part D financial Extra Help

If you are eligible for Medicare and having difficulties paying for your prescription drugs, you may want to learn more about the Medicare Part D Extra-Help program by calling or visiting a local state Medicaid office or calling the Social Security Administration at 1-800-772-1213.

Extra Help or the Low Income Subsidy (LIS) is a government program that helps Medicare beneficiaries pay all or part of their monthly Medicare Part D drug plan premiums, deductibles, and may cover a significant portion of their prescription drug costs.

If you already qualify for Medicaid, you will automatically qualify for the Medicare Part D Extra Help and do not need to apply.

However, even if you do not meet the financial qualifications for your state Medicaid program, you may still qualify for Extra Help benefits based on your annual income and financial resources (or assets) - and save money on your prescription drugs. 

No change in 2026 finances?
With changes in annual qualification requirements, you may now qualify for Extra Help.

Extra Help qualification limits change each year - and the 2026 income and resource limits for the Medicare Part D “Extra Help” program have recently been increased, so you may now be eligible for the “Extra Help” program --- even if you have not experienced changes in your financial situation.

Did the January increases in your 2026 Social Security benefits make you lose your Extra Help status?
You can reapply now for 2026 Extra Help.

Some people may have lost their Part D Extra Help benefits this past January when their monthly Social Security benefits increased pushing them above the Extra Help income limits, but these people are urged to re-apply for 2026 Extra Help now based on the newly released Extra Help qualification limits.

Extra Help based on Income and Assets

• If your annual income is at or below 150% of FPL ($23,940 if you are single or $32,460 for married couples), you could qualify for the Low-Income Subsidy (resource or asset limits also apply).

Question:  Can I qualifying for partial-LIS benefits?

No. Partial-LIS no longer exists.  The good news is that, if you qualified for partial-LIS in 2023, you should qualify for full-LIS benefits now.  Plan year 2023 was the last year for partial Extra Help.  For plan year 2024 and beyond, the Inflation Reduction Act (IRA) increased full-Extra Help benefits to people at or below 150% of FPL and consequently, the 2023 partial Extra Help (135% to 150% of FPL) designation was eliminated.


Important:  Again, even if you did not qualify for Extra Help last year, you may now qualify based on the new FPL Guidelines.


 
Learn more in our article, 2026 Federal Poverty Level Guidelines (FPL): 2026/2027 LIS Qualifications and Benefits.


Your tax return and changing financial status

Typically, the Extra Help application uses the most recent tax return information sent to Social Security from the IRS.  This would currently be your 2023 tax return (filed in 2024).  However, if you have had significant changes in your income in comparison to your tax return, you can appeal to Social Security to use more recent income figures.  Please see: How to appeal the decision Social Security made on your application for Extra Help.

Qualifying for Medicaid and Medicaid Spend-down

As a reminder, Medicaid “Spend down” allows you to subtract your medical expenses (for example, what you pay for your prescription medications) from your annual income so that you might become eligible for your state’s Medicaid program based on the cost of healthcare.  In other words, you may be eligible for your state’s Medicaid program based on the principle of “Spend-Down”, even if you would otherwise earn too much to qualify for Medicaid.  You can click here to read more about Medicaid Spend Down.

Extra Help status and changing 2026 Medicare Part D or Medicare Advantage plans.

If you qualify for Extra Help, you may be granted a Special Enrollment Period (SEP) allowing you to change your Medicare plan at various times during the plan year.  You can Read more about the dual-eligible Special Enrollment Period (SEP) and/or telephone a Medicare representative at 1-800-Medicare (1-800-633-4227) for assistance finding the most economical health and prescription drug coverage.

Question:  How do I apply for the Medicare Part D Extra Help program?

To apply for Extra Help go to: secure.ssa.gov/i1020/start. You could receive Extra Help for the remainder of 2026, even if your income or assets no longer meet the requirements later in the year.  You can also apply for Extra Help through your local state Medicaid office.


To review copayments for Full-LIS (and pre-2024 Partial-LIS), select the year link below:

2027 LIS Copayment Benefits:  100% FPL    100% to 150% FPL
2026 LIS Copayment Benefits:  100% FPL    100% to 150% FPL
2025 LIS Copayment Benefits:  100% FPL    100% to 150% FPL
2024 LIS Copayment Benefits:  100% FPL    100% to 150% FPL
2023 LIS Copayment Benefits:  100% FPL    135% FPL     150% FPL
2022 LIS Copayment Benefits:  100% FPL    135% FPL     150% FPL
2021 LIS Copayment Benefits:  100% FPL    135% FPL     150% FPL
2020 LIS Copayment Benefits:  100% FPL    135% FPL     150% FPL
2019 LIS Copayment Benefits:  100% FPL    135% FPL     150% FPL
2018 LIS Copayment Benefits:  100% FPL    135% FPL     150% FPL
2017 LIS Copayment Benefits:  100% FPL    135% FPL     150% FPL
2016 LIS Copayment Benefits:  100% FPL    135% FPL     150% FPL
2015 LIS Copayment Benefits:  100% FPL    135% FPL     150% FPL
2014 LIS Copayment Benefits:  100% FPL    135% FPL     150% FPL
2013 LIS Copayment Benefits:  100% FPL    135% FPL     150% FPL