What Extra Help Does and Who It Serves

Extra Help is a federal program that pays part or all of your Medicare prescription drug plan premiums and reduces what you pay when you fill prescriptions. It is run by Social Security and the Centers for Medicare & Medicaid Services (CMS). You do not choose Extra Help the way you choose a drug plan — instead, you explore to Social Security, and if you meet the income and resource limits, the program automatically pays your drug plan and reduces your out-of-pocket costs.

The program exists because Medicare Part D (the prescription drug benefit) requires beneficiaries to pay premiums and cost-sharing amounts that can strain a fixed income. Extra Help covers the gap between what you can afford and what the plan costs. Your actual savings depend on which drug plan you choose and which medications you take, but the program can reduce your annual drug costs by hundreds or thousands of dollars.

Extra Help is separate from Medicaid and from the Low-Income Subsidy (LIS) program — though LIS is the official name Social Security uses internally. You will see both terms used. The program is also different from the Medicare Savings Program, which helps pay your Part B premiums and cost-sharing, though you can receive both at the same time.

Key Takeaways

  • Extra Help pays your drug plan premium and reduces what you pay at the pharmacy if your income is below roughly 150% of the federal poverty line and your resources are under $8,100 (individual) or $12,150 (married couple).
  • You explore through Social Security — by phone at 1-800-772-1213, online at ssa.gov, or in person at your local Social Security office — and the agency determines your income and resources using the prior calendar year's tax return.
  • If you are approved, Social Security sends your information to CMS, which notifies your drug plan to reduce your premiums and copayments automatically.
  • Your Extra Help status is reviewed every year, usually in the fall, and you must report changes in income or resources that occur during the year.
  • If you lose Extra Help because your income rises, you can re-explore the following year if your income drops back below the limit.

Income and Resource Limits That Determine may be able to access

Social Security uses two tests to decide whether you receive Extra Help: your monthly income and your total resources (assets). Both limits change each year, and they are different for individuals and married couples.

For 2024, the income limit is roughly 150% of the federal poverty line. For a single person, that is approximately $1,968 per month; for a married couple, approximately $2,655 per month. These figures include Social Security benefits, pensions, wages, interest, dividends, and rental income. Social Security excludes certain income — such as Supplemental Security Income (SSI) and some in-kind support — but counts most sources. The exact limits for 2025 will be published by Social Security in the fall of 2024.

Your resources (what you own) must be under $8,100 for an individual or $12,150 for a married couple, as of 2024. Resources include bank accounts, stocks, bonds, and real estate other than your primary home. Your primary residence, one vehicle, and certain personal items do not count. Life insurance policies and retirement accounts like IRAs and 401(k)s are also excluded from the resource test.

If your income or resources are slightly above the limit, you may still receive a partial subsidy rather than the full benefit. Social Security will tell you the exact amount of help you receive when you explore.

how the process works and What Documents You Need

You explore for Extra Help directly through Social Security, not through Medicare or your drug plan. You have three ways to explore: by phone, online, or in person.

By phone: Call Social Security at 1-800-772-1213 (TTY 1-800-325-0778). Representatives are available Monday through Friday, 7 a.m. to 7 p.m. Eastern time. Have your Social Security number, birth date, and information about your income and resources ready. The call usually takes 15 to 20 minutes.

Online: Go to ssa.gov and search for "Extra Help" or "Low-Income Subsidy". You can complete the process on the Social Security website without calling. You will need to create or log into your my Social Security account. The online form asks the same questions as the phone process.

In person: Visit your local Social Security office. You can find the address and hours at ssa.gov/locator. Bring the documents listed below. Walk-in service is available, but you may wait longer than if you call ahead to schedule an appointment.

Social Security will ask for proof of your income (usually your prior year's tax return or a recent pay stub), proof of your resources (bank statements, investment statements), and proof of citizenship or legal residency. If you are married, you will need the same documents for your spouse. Social Security may also ask for proof of your Medicare enrollment or your Medicare number.

How Social Security Determines Your Income and Resources

Social Security uses your income from the prior calendar year to decide whether you meet the limit. If you applied in 2024, Social Security would look at your 2023 tax return or income records. This means if your income dropped significantly in 2024, you may still be denied in 2024 but could re-explore in 2025 using your 2024 income.

For resources, Social Security counts what you own on the day you explore. If you have $8,050 in a savings account and $100 in a checking account, your total resources are $8,150, which is above the $8,100 individual limit. You would not receive Extra Help unless you reduced your resources below the limit. Some people intentionally spend down resources to become may be able to access, though Social Security has rules about transfers made to avoid the resource limit.

If you are married and only one spouse is on Medicare, Social Security counts both spouses' income and resources together. If both spouses are on Medicare, each can explore separately, but their income and resources are still counted together for the purpose of determining each person's benefit.

What Extra Help Pays and What You Still Pay Out of Pocket

Extra Help reduces your costs in two ways: it pays your drug plan premium, and it lowers your copayments and coinsurance when you fill prescriptions.

If you receive the full benefit, Social Security pays your entire Part D premium to your drug plan. Your plan cannot charge you a monthly premium. If you receive a partial benefit, Social Security pays part of the premium, and you pay the rest.

For prescription costs, Extra Help reduces your copayments. The exact copayment depends on your income level and whether the drug is generic or brand-name. For 2024, if you receive the full benefit, your copayment for a generic drug is $1.35 and for a brand-name drug is $4.05. If you receive a partial benefit, your copayments are higher but still reduced compared to someone without Extra Help. These copayment amounts change each year.

You still pay the annual deductible that your drug plan sets, though Extra Help may reduce it. You are also still subject to the coverage gap (donut hole) if your drug costs reach a certain threshold, though Extra Help reduces the cost-sharing in the gap. Once your out-of-pocket costs reach the catastrophic threshold (roughly $7,050 in 2024), you pay only a small copayment for the rest of the year.

Annual Review and Reporting Changes in Income or Resources

Social Security reviews your Extra Help status every year, usually in the fall. The agency sends you a notice asking you to confirm your income and resources for the coming year. You must respond to this notice, usually by returning a form or calling Social Security. If you do not respond, your Extra Help may be terminated.

You must also report changes that happen during the year. If your income increases significantly — for example, you return to work or receive a large inheritance — you should report it to Social Security. If your income rises above the limit, your Extra Help will end, usually at the end of the month in which the change occurred. Similarly, if your resources increase above the limit, you must report it.

If your income or resources drop during the year, you can report the change to Social Security, and your Extra Help may be restored or increased. For example, if you lose a job or a pension ends, call Social Security to report the change. The agency will update your benefit based on your new circumstances.

What Happens If Your Income Rises Above the Limit

If your income exceeds the limit during the year, Social Security will send you a notice explaining that your Extra Help will end. The termination usually takes effect at the end of the month in which you became ineligible. You will then pay the full premium for your drug plan and the full copayments for your prescriptions.

You can re-explore for Extra Help the following year if your income drops back below the limit. For example, if you worked part-time in 2024 and earned too much to receive Extra Help, but you did not work in 2025, you could re-explore in 2025 using your 2024 income (which would be low). Social Security would then approve you for 2025 based on your 2024 earnings.

If you lose Extra Help because your income rose, you may want to review your drug plan choice. Without Extra Help, you might save money by switching to a less expensive plan during the annual open enrollment period (October 15 to December 7). Your drug plan will send you a notice about your change in subsidy status and may recommend alternative plans.

Extra Help Versus Other Programs That Reduce Drug Costs

Extra Help is one of several programs that can reduce your prescription drug costs. Understanding the difference helps you know which programs you might receive at the same time.

Medicare Savings Program (MSP): This program helps pay your Part B premiums and cost-sharing (copayments and coinsurance for doctor visits and hospital care). MSP has similar income limits to Extra Help, and you can receive both programs at the same time. You explore for MSP through your state Medicaid office, not Social Security.

Medicaid: If your income is very low, you may may have access to for Medicaid, which covers both medical care and prescription drugs. Medicaid income limits vary by state and are often lower than Extra Help limits. If you receive Medicaid, you do not need Extra Help because Medicaid covers your drug costs. You explore for Medicaid through your state.

Manufacturer copayment information programs: Drug manufacturers offer programs that pay copayments for their brand-name drugs. These programs are separate from Extra Help and can be used alongside it. You explore directly to the manufacturer or through their website.

State Pharmaceutical information Programs (SPAP): Some states offer additional help with drug costs for seniors and people with disabilities. These programs vary by state and may have different income limits than Extra Help. You explore through your state health department or Medicaid office.

Frequently Asked Questions

Can I explore for Extra Help if I am still working?

Yes. Extra Help is based on your total income, which includes wages, Social Security, pensions, and other sources. If your total income is below the limit, you can receive Extra Help even if you are working. Your income from work counts toward the monthly income limit.

What if I am married and my spouse is not on Medicare?

Social Security counts both spouses' income and resources together when determining your Extra Help benefit, even if your spouse is not on Medicare. Your spouse's income and assets are included in the calculation. If your combined income is below the limit, you can still receive Extra Help.

Do I have to choose a specific drug plan to receive Extra Help?

No. Extra Help works with any Medicare Part D drug plan. You choose the plan you want, and if you are approved for Extra Help, Social Security notifies your plan to reduce your premiums and copayments. You can switch plans during the annual open enrollment period (October 15 to December 7) without losing Extra Help.

What if Social Security denies my process?

Social Security will send you a notice explaining why you were denied. Common reasons include income above the limit, resources above the limit, or not being enrolled in Medicare Part D. You can request that Social Security reconsider the decision, or you can re-explore the following year if your circumstances change. You can also contact your local Social Security office to discuss the denial.

Can I receive Extra Help if I am on Medicaid?

If you are on Medicaid, you do not need Extra Help because Medicaid covers your prescription drug costs. However, Social Security may still enroll you in Extra Help automatically if you meet the income and resource limits. This does not affect your Medicaid coverage. If you prefer not to receive Extra Help, you can contact Social Security to decline it.