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

What are the benefits of Medicare “Extra Help?”³

“Extra Help” supports people who are on Medicare and also qualify for their state’s Medicaid program. 2025 benefits include:²

• No or reduced monthly premium
• No annual deductible
• Paying no more than $4.90 for each generic/preferred multi-source drug or biosimilar
• Paying no more than $12.15 for all other drugs

Once your total drug costs (including certain payments made on your behalf, like through the Extra Help program) reach $2,000, you’ll pay $0 for each covered 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 when you’re first eligible for a Part D plan. 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 .

How do I apply for “Extra Help?” 

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

• 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 opens in new window
• Phone—Call 800-772-1213 (TTY: 800-325-0778)
• In person—Visit your local Social Security office opens in new window

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

If you qualify for Extra Help

Every member is responsible for following all the rules and procedures in the Evidence of Coverage (EOC). Download this document in the appropriate language below.

Extra Help Rider – English pdf opens in new window

Extra Help Rider – Spanish pdf opens in new window

Extra Help Rider – Chinese pdf opens in new window

A little can go a long way

“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 .