Some individuals enrolled in Medicare may have an income level that allows them to receive financial assistance with prescriptions. The program that provides this assistance is Medicare Part D Extra Help. Eligible beneficiaries can apply for Extra Help anytime either before or after they enroll in Part D.
Medicare Part D Extra Help
Medicare Part D is the prescription drug coverage plan that helps Medicare beneficiaries pay for prescription medications. However, the costs associated with these plans; premiums, deductibles, co-pays, and coinsurance can add up, especially for those with limited income. Medicare Part D Extra Help (LIS) provides financial assistance to beneficiaries with limited income and resources. This helps reduce the costs of necessary prescription drugs. This program provides a lifeline for those who may not otherwise be able to afford their medications.
Who Qualifies for Extra Help
To qualify for Medicare Part D Extra Help, individuals must meet specific income and asset criteria. Although the SSA adjusts the limits annually, generally, individuals qualify if:
Their annual income is below a set threshold. As of 2025, the income limit for individuals is $22,590, and for a married couple, it is $30,660.
Asset limits; such as bank accounts, stocks, and bonds should be at or below a specific amount. In 2025, the resource limits are $16,100 for an individual and $32,130 for a married couple. Please note; resources like a primary residence and car do not count.
If income and assets are slightly above the limits, beneficiaries may qualify for a partial subsidy, which provides some help with prescription drug costs.
What Does Extra Help Cover
Extra Help provides assistance with several aspects of Medicare Part D costs, including:
- Lower Premiums: Those who qualify may have a lower or even a $0 premium for their Part D plan depending on the personal finances.
- Reducing Deductibles and Co-pays: Extra Help lowers out-of-pocket costs for prescription drugs, including deductibles, copays, and coinsurance.
- Eliminating the Coverage Gap: Also known as the “donut hole,” this is a temporary coverage gap in most Part D plans. Extra Help may completely eliminate this gap, so you won’t have to pay higher costs during this phase. Although in 2025,this is a non-option as the coverage gap will be eliminated.
- Lowering Drug Costs: The program also reduces the cost of prescription drugs, especially if they’re generic medications.
How to Apply for Extra Help
Medicare beneficiaries can apply for Extra Help in several ways:
- Online: Visit the Social Security Administration (SSA) website and complete the application form online.
- By Phone: Call SSA at 1-800-772-1213 (TTY 1-800-325-0778) to apply by phone. They can walk you through the process.
- In Person: You can apply in person at your local Social Security office; just call +1 800-772-1213 or TTY 1-800-325-0778. Tell the representative you need an appointment to apply for Part D Extra Help.
Those who apply must provide information about income, assets, and any resources that might affect their eligibility.
After the application is submitted
Once the applicant submits their application, SSA reviews the information provided. Usually within 30 days, SSA sends out a notice to let applicants know if they’re approved. The notice will notify them of the specific level of assistance they qualify for. Those who are denied have the right to appeal the decision.
Those who receive Extra Help can continue using the PDP plan they already have, or may be automatically enrolled in a plan that best fits their needs. It’s important to review plan options each year during the Medicare AEP (October 15 – December 7) to make sure the current plan is still the best choice.
Watch a YouTube video and learn about changes for Dual, Partial Dual and LIS SEP changes
Can you remove or change Extra Help
Yes, Extra Help is subject to change if the beneficiary’s financial situation changes. If there is an increase in income or assets, beneficiaries may no longer qualify for the full subsidy. However, they may still qualify for a partial subsidy if income and assets are within specified limits.
Those who are unsure if they are eligible should reach out to the Social Security Administration or their Medicare agent for more information.
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