Key Takeaways
- Extra Help (the Part D Low-Income Subsidy) is a federal program that can pay your full Medicare drug plan premium, eliminate your deductible, and cap your copays at $5.10 for generics and $12.65 for brand-name drugs in 2026.
- The 2026 income limit is roughly $23,475/year for an individual or $31,725/year for a married couple (150% of the federal poverty level).
- The 2026 resource limit is $16,590 single / $33,100 married, but you can exclude up to $1,500 per person in burial funds, raising it to $18,090 / $36,100.
- If you already receive Medicaid, SSI, or a Medicare Savings Program, you're automatically enrolled in Extra Help - no separate application needed.
- Everyone else applies directly through the Social Security Administration at ssa.gov/extrahelp or by calling 1-800-772-1213.
- No existing income or resource test disqualifies you permanently - you can reapply if your situation changes, and SSA reviews most recipients' eligibility annually.
If you’re on Medicare and drug costs are eating into a fixed income, there’s a federal program that quietly covers a lot of that gap — and a meaningful number of people who’d qualify never apply, often because they’ve never heard of it or assume their income is too high. It’s called Extra Help, formally the Part D Low-Income Subsidy (LIS), and depending on your income and resources, it can pay your entire drug plan premium and cut your copays to a few dollars.
Here’s exactly who qualifies in 2026, what it actually covers, and how to apply.
What Extra Help Actually Covers
Extra Help isn’t a discount card or a coupon — it’s a federal subsidy that changes what you pay across your entire Part D drug plan, at every point where you’d normally pay something:
- Your monthly premium: Extra Help can cover your full Part D premium, up to a regional benchmark amount. If your plan costs more than the benchmark, you may owe a small difference, but many low-cost plans in each region are fully covered.
- Your annual deductible: Eliminated entirely for full-subsidy recipients — you pay nothing before your plan’s coverage starts.
- Your copays: Capped at $5.10 for generic drugs and $12.65 for brand-name drugs in 2026, no matter how expensive the drug’s list price actually is.
- The coverage gap: Extra Help recipients don’t experience the coverage gap (“donut hole”) the way other Part D enrollees historically did — your copay stays capped throughout the year rather than jumping partway through.
Depending on your exact income and resources, you may qualify for full Extra Help (the benefits above in full) or partial Extra Help (a reduced premium and slightly higher, but still capped, copays). SSA determines which tier applies based on where your income and resources fall within the limits. For the rest of what’s changed with Medicare drug coverage this year — including the new $2,100 out-of-pocket cap that applies whether or not you get Extra Help — see my rundown of 2026 Medicare coverage changes.
2026 Income and Resource Limits
Income limit: To qualify for full Extra Help in 2026, your annual income generally needs to be at or below 150% of the federal poverty level — roughly $23,475 for an individual or $31,725 for a married couple living together. Income counted here includes wages, Social Security, pensions, and most other regular income sources.
Resource limit: Your countable resources need to be at or below $16,590 for an individual or $33,100 for a married couple. Countable resources include checking and savings accounts, CDs, stocks, bonds, mutual funds, and IRAs — but not your home, one vehicle, or personal belongings.
The burial fund exception: You can exclude up to an additional $1,500 per person set aside for burial expenses from your countable resources, if you notify SSA about it. That raises the effective resource limit to $18,090 single / $36,100 married for anyone who designates funds this way.
Income and resource limits that fall slightly above the full-subsidy thresholds may still qualify you for partial Extra Help on a sliding scale, so it’s worth applying even if you’re not certain you fall under the full limits.
Who Gets Extra Help Automatically
You don’t need to apply separately if you already have any of the following — SSA and CMS enroll you automatically:
- Full Medicaid coverage (sometimes called “dual eligible” if you also have Medicare)
- Supplemental Security Income (SSI) — the 2026 federal maximum is $994/month for an individual
- A Medicare Savings Program (QMB, SLMB, or QI) that helps pay your Part B premium
If you fall into any of these categories, you should already be receiving Extra Help without having filed a separate application. If you’re not sure whether you’re enrolled, check your Medicare account at medicare.gov or call 1-800-MEDICARE.
How to Apply
If you don’t automatically qualify through Medicaid, SSI, or a Medicare Savings Program, you apply directly with the Social Security Administration, not with Medicare or a specific drug plan:
- Apply online at ssa.gov/extrahelp — this is the fastest method and lets you check your application status afterward.
- Apply by phone by calling SSA at 1-800-772-1213 (TTY 1-800-325-0778).
- Apply in person at your local Social Security office.
- Get help through your State Health Insurance Assistance Program (SHIP), which offers free, unbiased counseling on Medicare programs including Extra Help — a useful option if you want someone to walk through the application with you.
There’s no specific enrollment period for Extra Help — you can apply anytime during the year, and SSA processes applications on a rolling basis. If you’re approved, the subsidy generally applies going forward from your approval date, and SSA reviews most recipients’ continued eligibility annually.
If you’re weighing Extra Help alongside a broader Social Security claiming decision — for instance, timing when you file so your income doesn’t tip you over the resource limit — my guide to claiming Social Security in 2026 walks through the tradeoffs.
Extra Help Also Triggers a Special Enrollment Period
If you’re approved for Extra Help, you also gain a Special Enrollment Period (SEP) that lets you switch Part D drug plans (or add one, if you have Original Medicare without drug coverage) outside of the standard annual Open Enrollment window. This is a meaningful side benefit — it means you’re not stuck with a plan that doesn’t fit your medications until the next Open Enrollment period rolls around.
Common Issues to Watch Out For
Assuming your income is too high without checking. The income limits are higher than many people expect, and even income slightly above the full-subsidy threshold can still qualify you for partial Extra Help.
Not knowing you’re already enrolled. If you have Medicaid, SSI, or a Medicare Savings Program, double-check your Part D plan’s premium and copay amounts — if you’re not seeing the reduced costs Extra Help should provide, contact SSA, since something in the automatic enrollment process may not have gone through correctly.
Forgetting the burial fund exclusion. If your resources are close to the standard limit, formally designating up to $1,500 per person for burial expenses and notifying SSA could be the difference between qualifying and not.
Assuming Extra Help covers every drug at the capped copay. The caps apply to drugs on your plan’s formulary. If your specific medication isn’t covered by your plan at all, Extra Help doesn’t change that — you may need to request a formulary exception or switch plans during your SEP.
