What Is Medicare Extra Help?
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Extra Help pays for some or all of your premiums and out-of-pocket costs for Medicare Part D (prescription drugs).
Full Medicaid coverage, SSI and certain Medicare Savings Programs automatically qualify you for Extra Help.
You can also qualify if you meet income and resource limits.
You apply for Extra Help through the Social Security Administration.
Extra Help is a federal program that helps Medicare beneficiaries with low income and limited resources pay for prescription drugs with Medicare Part D.
The government estimates that Extra Help — also known as the Part D Low-Income Subsidy — is worth about $5,900 per year.
Here’s what you need to know about the benefits, requirements and application process for Extra Help.
Medicare will have big changes in 2025. Compare Medicare Part D Plans
Medicare Extra Help eligibility
You can qualify for Extra Help if you are entitled to Medicare Part A and/or Part B, live in any of the 50 states or Washington, D.C., are not incarcerated and have both limited resources and limited income.
There are two ways to get Extra Help:
Automatically. If you get assistance from certain government programs, you qualify for Extra Help automatically. You don’t need to apply.
By applying. If you don’t get Extra Help automatically, you can apply and qualify if your income and resources are below certain limits.
Who automatically receives Extra Help?
You're automatically eligible for Extra Help if you have Medicare Part A and/or Part B and at least one of the following applies:
You're entitled to Supplemental Security Income, or SSI.
You're eligible for full Medicaid coverage.
You're enrolled in a Medicare Savings Program as a Qualified Medicare Beneficiary, Specified Low-Income Medicare Beneficiary or Qualified Individual.
If you automatically qualify, you don’t need to apply to receive the benefits.
If you don’t automatically qualify, you should still apply for Extra Help if you might meet the income and resource criteria.
» MORE: What if I can’t afford Medicare?
Extra Help income limits
The income limit to qualify for Extra Help is 150% of the federal poverty level (FPL). In 2024, Extra Help income limits for the 48 contiguous states and Washington, D.C. are:
For individuals: $22,590 per year.
For married couples: $30,600 per year.
That’s $1,882.50 per month for individuals or $2,555 per month for married couples in Washington, D.C. and most states. (Alaska and Hawaii have different income limits.)
The latest income thresholds for all states and household sizes can be found on the Department of Health and Human Services’ HHS Poverty Guidelines for 2024.
There are many exceptions to what counts as income. For example, food, housing and home energy assistance from the government, scholarships, grants and even payments you get from others to help with your household expenses don’t count toward Extra Help’s income limits.
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Extra Help resource limits
Extra Help also has resource limits. “Resources” include your bank accounts, cash at home, investments like stocks and bonds, and real estate other than your primary residence.
For 2024, the Extra Help resource limits are:
For individuals: $17,220.
For married couples: $34,360.
The resource limits include an additional allowance for beneficiaries who plan to use some resources for burial expenses. That allowance increases the limits by $1,500 for individuals or $3,000 for married couples.
Not everything you own counts as a “resource.” For example, your home, personal possessions, vehicles, insurance policies, back payments from Social Security or SSI, and burial plots or contracts don’t count toward the resource limits.
Extra Help benefits
Extra Help applies to your choice of Medicare Part D plan or Medicare Advantage plan with prescription drug coverage. For qualifying beneficiaries, Extra Help provides:
Premiums: Subsidized up to 100% of the cost of benchmark Part D premiums in your area. (You will need to pay the difference if you choose a more expensive Part D plan.)
Deductibles: Eliminated ($0) for all qualifying beneficiaries.
Copays: Capped at $4.50 for generic drugs and $11.20 for brand-name drugs for most people.
What are the changes for Medicare Extra Help in 2024?
Previously, there were lower income limits to qualify for full Extra Help subsidies, but it was possible to qualify for partial Extra Help subsidies at certain income levels. As of 2024, people making up to 150% of the FPL can qualify for the full subsidy.
How do I apply for Extra Help?
You apply for Extra Help through the Social Security Administration:
Online: Visit ssa.gov/medicare/part-d-extra-help.
Phone: Call 800-772-1213 (TTY 800-325-0778).
In person: Visit your local Social Security office — find yours at ssa.gov/locator.
You will need to provide information about your household, work, resources and monthly income as part of the application.
Should I apply for Extra Help if I don’t quite meet the income or resource limits?
Yes. There are many exceptions to what counts as income and resources. It’s possible you could meet the requirements once those exceptions are factored in.
Even if you don’t meet the requirements, you can apply for Extra Help and other assistance programs at the same time using the same information, so you might be able to get help from another program.
Do I need to be enrolled in Medicare Part D to apply for Extra Help?
No. You’ll be automatically enrolled in a Medicare Part D prescription drug plan if you qualify for Extra Help and you’re not already enrolled. If you want another plan instead, you can switch.
