What is Medicare Extra Help? (Medicare Part D’s Low-Income Subsidy)

To qualify for Extra Help, you must:

• Live in the United States
• Be enrolled in or eligible for a Part D prescription drug plan
• Meet the income limit
• Meet the resource limit

Income refers to how much money you (and your spouse if you’re married) make in a calendar year.

Resources include the value of the things you own. Some examples include:

• Real estate (other than your primary residence)
• Bank accounts (checking, savings and certificates of deposit)
• Stocks
• Bonds (including U.S. Savings Bonds)
• Mutual funds
• Individual Retirement Accounts (IRAs)
• Cash at home or anywhere else

There are 2 levels of Extra Help: full and partial. Here’s a breakdown of their benefits:³

Full Extra Help benefits

Full Extra Help supports people who are on Medicare and also qualify for their state’s Medicaid program. Benefits include:

• No monthly premium
• No annual deductible
• Paying no more than $4.15 for each generic drug
• Paying no more than $10.35 for each brand-name drug

Once your total drug costs (what both you and your plan pay) reach $7,400, you’ll pay $0 for each covered drug. If you also get full Medicaid coverage and are in the Qualified Medicare Beneficiary (QMB) program, you’ll pay no more than $4.30 for each covered drug.

Partial Extra Help benefits

Some people with higher incomes may be able to get partial Extra Help. These benefits include:

• Lower premiums based on your income
• Deductibles no more than $104
• Drug costs no more than 15% for each covered drug

Once your total drug costs (what both you and your plan pay) reach $7,400, you’ll pay no more than $4.15 for each generic drug and $10.35 for each brand-name drug.

Other benefits of Extra Help

In addition to lower out-of-pocket costs, Extra Help gives you:

• No Part D late enrollment penalty—Medicare charges this penalty to people who don’t sign up for Part D drug coverage before the Medicare enrollment period deadlines. You will not be charged this penalty.
• Special Enrollment Periods—Most people with Medicare can only make changes to their drug coverage at certain times of the year. If you get Extra Help, you may have access to these special enrollment periods.

Some people automatically qualify for Extra Help and others have to apply. You'll automatically receive Extra Help if you get:⁴

• Full Medicaid coverage
• Help from your state paying your Part B premiums
• Supplemental Security Income (SSI) benefits from Social Security

If you don’t automatically qualify for Extra Help, you can apply through the Social Security Administration in 3 ways:

• Online—Go to the Social Security Administration’s website
• Phone—Call 800-772-1213 (TTY: 800-325-0778)
• In person—Visit your local Social Security office

Note: If you don’t qualify for Extra Help now, you can reapply at any time if your income and resources change.

Extra Help can help pay for all or most of your monthly Medicare premiums and annual deductibles, plus lower your prescription copayments. For more ways to potentially save on out-of-pocket costs, check out these other Medicare Savings Programs.