Since 2011, we've helped more than 5 million visitors understand Medicare coverage.

A PROPERTY OF HEALTHINSURANCE.ORG, LLC, A NON-GOVERNMENTAL ENTITY

Learn about Medicare plans.*

Explore plans from a licensed agency!

Home > FAQs > How do I qualify for Medicare’s Extra Help?

featured-image

How do I qualify for Medicare’s Extra Help?

Louise Norris | August 9, 2024

Reviewed by our health policy panel.

How do I qualify for Medicare's Extra Help Program?

Lower-income Medicare beneficiaries may receive financial assistance through Medicare’s Extra Help program. If you have difficulty paying for prescriptions, the Extra Help program – also known as the Low-Income Subsidy (LIS) – can make prescriptions and plan premiums more affordable than they would be with Medicare Part D alone.

Am I eligible for Extra Help?

Your income (from the prior year) and resources determine the level of help you receive. You’ll automatically receive Extra Help if you have both Medicare and Medicaid, a Medicare Savings Program, or Supplemental Security Income, or Medicare only but also a limited income.

Before 2024, there were two different categories of Extra Help (full and partial) but that changed in 2024 under the Inflation Reduction Act. Everyone eligible for Extra Help now gets full Extra Help benefits.

To be eligible for Extra Help, your income in 2024 cannot exceed $22,590 for an individual or $30,660 for a married couple living together. In addition, resources must not exceed $17,220 for an individual and $34,360 for married couples (the financial limits are higher if you have dependents living with you, or if you live in Alaska or Hawaii).

Resources do not include the value of your car or home, but do include stocks, bonds, and bank accounts. A recent law excludes some additional resources, making it easier for more beneficiaries to get Extra Help: life insurance policies don’t count as resources, and financial assistance you receive from friends or relatives to help pay your household expenses is not considered income. (The Social Security Administration has more details about what does and doesn’t count as resources).

Will Extra Help reduce my out-of-pocket costs?

Enrollees who receive full Extra Help in 2024 will pay no more than $4.50 for each generic drug and $11.20 for brand-name drugs. This is a valuable benefit that the Social Security Administration estimates is worth an average of about $5,900 per year.1 For Extra Help enrollees with income below the poverty level who are also enrolled in Medicaid, copays are limited to $1.55 for generics and $4.60 for brand-name drugs.

In addition to having lower copayments, Extra Help enrollees also have their Part D plan deductibles reduced or eliminated altogether (depending on their income). The federal government also pays Part D premiums on behalf of Extra Help enrollees – up to a benchmark amount (this amount is different in each state; the number of plans with no premium for Extra Help enrollees in each state ranges from 2 to 7 in 2024), and eliminates the Part D late enrollment penalty for beneficiaries who would otherwise have to pay it.

CMS estimates that up to 2 million Medicare enrollees may be eligible for Extra Help but not enrolled. If you think you might be eligible, apply online or call Social Security at 1-800-772-1213.

Does Extra Help allow me to change my Part D coverage?

Yes. If you qualify for Extra Help, you can switch your Part D coverage up to once per quarter during the first three quarters of the year. There’s no plan change provision during the final quarter of the year, but that’s when Medicare’s annual open enrollment period occurs, allowing anyone with Part D coverage the opportunity to pick a different plan that will take effect January 1.

Louise Norris is an individual health insurance broker who has been writing about health insurance and health reform since 2006. She has written dozens of opinions and educational pieces about the Affordable Care Act for healthinsurance.org. Her state health exchange updates are regularly cited by media who cover health reform and by other health insurance experts.

Footnotes
  1. ”Understanding the Extra Help with Your Medicare Prescription Drug Plan” Social Security Administration. Feb. 2024 ⤶

Tags: copayment, deductible, Extra Help, low-income, Medicare premiums, premiums, prescription drug coverage

Related Articles

8 ways to cut your prescription drug costs

8 ways to cut your prescription drug costs

But prescription drugs – and drug coverage – can be less expensive if you're willing to do a little research  and to reach out for help. Here are eight strategies that will empower you to take control of your drug coverage and your medication costs.

Read More
How Medicaid supports 1 in 5 Medicare enrollees

How Medicaid supports 1 in 5 Medicare enrollees

In 2016, an estimated 11.7 million Medicare beneficiaries – about 20 percent of all enrollees – were also enrolled in Medicaid and are known as dual-eligible beneficiaries or dual-eligibles. And while you might not hear that term often – or at all – it's worth your time to understand what it means to have both Medicare and Medicaid (especially if you or a loved one is part of the "Medicare-Medicaid" population).

Read More
Can recent immigrants to the United States get health coverage if they’re over 65?

Can recent immigrants to the United States get health coverage if they’re over 65?

Seniors who aren't eligible for Medicare – including immigrants – can purchase health insurance through the ACA marketplace, and may be eligible for income-based premium subsidies to offset the cost.

Read More
Making Medicare work for the poorest Americans

Making Medicare work for the poorest Americans

There are three main ways for lower-income Medicare beneficiaries to cover out of-pocket-costs when they can't afford to purchase a Medigap supplemental plan or a Medicare Advantage policy.

Read More
8 ways to cut your prescription drug costs

8 ways to cut your prescription drug costs

But prescription drugs – and drug coverage – can be less expensive if you're willing to do a little research  and to reach out for help. Here are eight strategies that will empower you to take control of your drug coverage and your medication costs.

Read More
How Medicaid supports 1 in 5 Medicare enrollees

How Medicaid supports 1 in 5 Medicare enrollees

In 2016, an estimated 11.7 million Medicare beneficiaries – about 20 percent of all enrollees – were also enrolled in Medicaid and are known as dual-eligible beneficiaries or dual-eligibles. And while you might not hear that term often – or at all – it's worth your time to understand what it means to have both Medicare and Medicaid (especially if you or a loved one is part of the "Medicare-Medicaid" population).

Read More
Can recent immigrants to the United States get health coverage if they’re over 65?

Can recent immigrants to the United States get health coverage if they’re over 65?

Seniors who aren't eligible for Medicare – including immigrants – can purchase health insurance through the ACA marketplace, and may be eligible for income-based premium subsidies to offset the cost.

Read More
Making Medicare work for the poorest Americans

Making Medicare work for the poorest Americans

There are three main ways for lower-income Medicare beneficiaries to cover out of-pocket-costs when they can't afford to purchase a Medigap supplemental plan or a Medicare Advantage policy.

Read More
See more articles
Find a plan.