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Now that is 2025, both Medicare beneficiaries and agents need to know what the Medicare premiums and deductibles 2025 are so that everyone can plan accordingly. 2025 is the same as previous years; CMS has made changes to both Medicare Part A & Part B premiums and deductibles.

Medicare Part A costs 2025

The majority of beneficiaries do not have to pay a Part A premium if they have worked for at least 40 quarters (10 years) and paid Medicare taxes. Although if they do not qualify for premium free Part A, there are a couple different premium amounts they can pay if they want Part A benefits.

When either the beneficiary or their spouse worked and paid Medicare taxes between 30 and 39 quarters, the monthly premium cost is $285 in 2025. This is an increase of $7 from the 2024 cost of $ 278.

If the beneficiary or their spouse worked at a job and paid Medicare taxes for less than 30 quarters, the premium in 2025 is $518. This an increase of $13 from the cost of $505 in 2024

Part A Deductible and Coinsurance 2025

Part A covers inpatient hospital costs. In 2025, the Part A deductible has gone up $1,676 for each benefit period. This is an increase of $44 from the cost of $1,632 in 2024.

On original Medicare once the beneficiary meets the deductible, the cost for a hospital stay is $0 for days 1-60. The cost for days 61-90 is $419 per day. This is $11 over the cost of $408 in 2024. Once the beneficiary reaches day 91 and over, they start to use their lifetime reserve days and pay $838 per day. that is up from $816 in 2024.

There is no coinsurance charge for days 1-20 in skilled nursing facility stays. The cost for days 21-100 are $209.50 per day in 2025. This is a $5.50 increase from the 2024 cost of $204.

Click here to learn about the Part D drug cap

Part B costs 2025

In contrast to the Part A premium, almost all beneficiaries have to pay a Part B premium. In special circumstances, if a beneficiary qualifies for extra help due to limited income and resources, they may not have to pay the Part B premium.

Part B Premiums & Deductibles

For 2025, the standard monthly premium has gone up $10.30 to $185.00. The premium was $174,70 in 2024.

Learn more about Part B costs

Those with an income level over a specified amount pay an IRMAA. The CMS adds the IRMAA to the standard monthly premium amount. The premium amount each beneficiary pays ranges from $259 to $628.90 per month if the beneficiary pays an IRMAA. The amount is based on their specific income level.

If you have been incorrectly charged an IRMAA, learn how to file an appeal.

The deductible amount for Part B in 2025 is $257, an increase of $17 from the 2024 cost of $240.

It is important for beneficiaries to stay updated on healthcare costs each year to manage their budgets and avoid surprises. CMS makes decisions on Medicare costs based on the projected rise in costs and use of healthcare.

Agents who want to join the team at Crowe, click here for contracting.

Many Medicare beneficiaries and agents have heard about the 2025 prescription payment. We will answer the question; what is the prescription payment plan. The plan is available to Medicare Part D beneficiaries. It provides a way to pay high out-of-pocket prescription costs by spreading them out over the course of months instead of all at once at the pharmacy. The prescription payment plan is sometimes called Smoothing. The payment plan is designed to make higher cost prescription drugs more affordable for Medicare beneficiaries.

How the program works

All Medicare Part D plan enrollees who have high cost prescriptions can participate in the prescription payment plan as long as the prescription is on their plan’s formulary. Plan enrollees can have their out of pocket prescription costs divided into manageable monthly payments over the course of the remaining months in the year.

Eligible beneficiaries simply contact their Part D insurance provider to opt into the program. The plan provider calculates the payments evenly over the course of the year. If the plan enrollee wants to add additional prescriptions to the payment plan, they contact their Part D insurance provider to have their payment arrangement adjusted. There is no charge to enroll in this program and beneficiaries do not pay interest or penalties.

Find out more about Part D costs for 2025

How to opt in to the prescription payment plan

It is not complicated to enroll in the plan. In some instances, Part D plan providers will contact beneficiaries who normally take high-cost prescriptions. Interested enrollees should contact the customer service number for their plan provider and request instructions to opt in.

Reasons to use the plan

There are many reasons to enroll in this program. For example; enrollment can provide a way for beneficiaries to manage their budget by spreading out the cost of their medication. This helps them avoid large pharmacy bills.

Knowing there is an alternative to a large bill, may help ensure beneficiaries fill their necessary prescriptions without financial stress. In some cases, beneficiaries may go without needed medications due to budget concerns. This can help eliminate that issue. The plan provides peace of mind with the safety of predictable monthly costs.

Learn about the $2,000 annual cap on Out-of-Pocket prescription costs

Watch a YouTube video on the drug cap for 2025

Because Medicare makes coverage changes each year, both agents and plan enrollees need to stay up to date on all information available. Knowing all the choices available helps beneficiaries receive needed coverage and plan for their year ahead. A licensed insurance agent can provide advice to ensure beneficiaries choose a plan that suite their needs and budget.

If you are a Medicare agent looking for an upline, click here for Crowe online contract

Medicare Part D in 2025: What You Need to Know

The prescription drug program, Medicare Part D 2025, is changing is significant ways. There are many updates to the program in an effort to reduce costs and improve affordability for beneficiaries. Take a look at the information below to see how these updates may effect both beneficiaries and agents.

Fewer plans available

Unfortunately, the average number of stand-alone Medicare Part D plans will decrease in 2025, with about 20 to 25 plans typically available in most states. The number of plan sponsors offering stand-alone PDPs will decrease from 11 in 2024 to 7 in 2025. In 2025 there will be only 464 plans available compared to 709 in 2024. This reduction highlights how important it is to compare plans carefully before making an enrollment decision.

Spending Cap

A major update is the introduction of a $2,000 annual cap on out-of-pocket spending for covered prescription drugs. Once the beneficiary reaches the limit, they do not pay any additional costs for medications covered under their plan. This change also eliminates the “donut hole” or coverage gap. This has been a long-standing concern for many enrollees​.

Agents – watch a YouTube video that explains the Drug Cap for 2025

Premiums and Costs

It is estimated that the average stand-alone Part D plan premium will be about $61.98. Although, weighted enrollment trends suggest a decline in cost to about $39.36 for many due to increased enrollment in lower-cost plans.

CMS approved the standard Part D deductible to increase to $590. Please note; the deductible does not apply to lower-tier drugs on many plans​.

Payment Smoothing

A new “payment smoothing” program will allow beneficiaries to spread out their out-of-pocket drug costs evenly over the course of the year. This may help ease some financial strain for those who take expensive drugs.

Learn more about PDP plan costs

Affordable Insulin and Vaccines

In 2025, Insulin copays remain capped at $35 for a 30-day supply, and vaccines that are recommended by the CDC’s Advisory Committee on Immunization Practices will continue to be available at no cost​ to Medicare PDP plan enrollees.

Why These Changes Matter

The redesign of Part D for 2025 focuses on affordability and accessibility. The cap on out-of-pocket spending, elimination of the coverage gap, and payment smoothing aim to reduce financial barriers, particularly for those who require expensive medications. These changes underscore the importance of reviewing plan options during the Annual Election Period to find one that best fits the beneficiary’s needs.

Please note; plan offerings can vary significantly by state.

For more information, consult resources such as the Medicare.gov website or a licensed Medicare agent to explore plan options tailored to your specific needs.

If you are a Medicare agent and want to join the team at Crowe; click here for online contracting.

Medicare provides crucial health coverage for millions of Americans, but timing is everything when it comes to enrollment. In some cases, missing the initial enrollment period can result in Medicare late enrollment penalties and a lapse in coverage.

We will provide some information about Medicare enrollment periods and how to avoid late enrollment penalties.

Enrollment periods for Original Medicare

1. Initial Enrollment Period (IEP): A 7-month window that starts 3 months before the 65th birthday, includes the birthday month, and extends 3 months after.
2. Special Enrollment Periods (SEP): Available for certain qualifying life events, such as losing employer-based coverage.
3. General Enrollment Period (GEP): Each year from January 1 to March 31 there is a general enrollment period for those who missed other enrollment opportunities.

Those who don’t sign up during their IEP and don’t qualify for an SEP may face late enrollment penalties.

Late enrollment penalties

1. Medicare Part A

Most people receive Part A premium-free if either they or their spouse paid Medicare taxes for at least 10 years. Although, if you must pay for Part A and do not enroll during your IEP, your monthly premium increases by 10%. This penalty applies for twice the number of years you delayed enrollment.

2. Medicare Part B

Those who neglect to sign up for Part B when either first eligible for Medicare or if they come off a qualified healthcare plan such as employer coverage receive a penalty.

The penalty they pay is a 10% increase in their monthly premium for every 12-month period they were eligible but didn’t enroll. The penalty applies to their premium for as long as they have Part B coverage.

3. Medicare Part D (Prescription Drug Coverage)

The Part D penalty is a 1% increase in the “national base beneficiary premium” for every month they went without Medicare prescription drug coverage (Part D) or other creditable prescription drug coverage.

Click here for the Part D late enrollment penalty calculator

Unfortunately, this penalty is similar to the Part B penalty and applies to the monthly premium for life as long as the beneficiary has Part D coverage.

GEP (General Enrollment Period)

Those who miss enrolling in Medicare Parts A or B during their IEP can sign up during the GEP. This enrollment period runs from January 1 to March 31 each year. Coverage starts the month after they sign up.

Please note: Those who use the GEP to enroll in Medicare A and/or B qualify for a Part D SEP to enroll o in a prescription drug plan. The SEP starts once they apply for Part A or Part B and lasts for two months. Prescription drug coverage starts the first day of the month after the month of enrollment.

Avoid Late Enrollment Penalties

1. Be aware of the IEP (Initial Enrollment Period) . Do not delay enrollment. It is important to sign up before the 7-month window for enrollment closes.
2. Make sure you maintain creditable coverage if you are on employer-sponsored health coverage. Be sure to your coverage qualifies as creditable to avoid penalties.
3. In the event you lose creditable coverage, use an SEP quickly to avoid a lapse in coverage.
4. Consult a licensed Medicare agent for advice and assistance navigating enrollment periods and eligibility requirements.

Watch our YouTube video on Medicare Enrollment Periods

Please note: individuals who have income and resources below specific limits may qualify for financial assistance programs and may not have to pay late enrollment penalties.

To Sum it up

Missing Medicare enrollment deadlines can result in significant penalties and coverage delays. Those either nearing 65 or managing Medicare on behalf of a loved one must be proactive to avoid making costly mistakes.

Many people have probably heard about some Medicare insurers suing CMS over their Star Ratings. This may lead to questions about Why Medicare Star ratings are important.

Star Ratings are determined annually by the CMS (Centers for Medicare and Medicaid Services). The ratings apply to Medicare Advantage and Part D (prescription drug plans).

They can help enrollees decide which plan is best in areas that are important to them. Choosing the right plan can impact both healthcare and finances. That is why CMS developed the Star rating system

What Are Star Ratings

Medicare Star Ratings evaluate the quality and performance of Medicare Advantage (Part C) and Medicare Part D prescription drug plans. Each plan is rated on a scale from 1 to 5 stars, with 5 being the highest. These ratings are updated each year and are based on many factors such as:

Customer satisfaction: This is based on customer ratings of each plan.

Clinical outcomes: How effective is the plan at keeping it’s members healthy.

Customer service: How do customers rate the responsiveness and support they received from plan representatives.

Drug safety and accuracy: This applies to Part D plans and it helps ensure safe and correct use of prescription drugs.

Why Medicare Star Ratings matter

1. Assessing Plan Quality: Star ratings give beneficiaries an easy-to-understand measure of a plan’s overall quality. Higher-rated plans generally provide better services, improved outcomes, and higher levels of customer satisfaction.
2. Influencing Plan Selection: Many beneficiaries use star ratings as one of the deciding factors when they compare plans. A higher star rating may mean a plan is more likely to meet healthcare needs.
3. Access to Special Enrollment: If a plan receives a 5-star rating, it qualifies for a Special Enrollment Period (SEP). This allows beneficiaries to switch to a 5-star plan one time per calendar year outside of standard enrollment periods. This can be crucial for individuals looking for better coverage options.
4. Improved Health Outcomes: Plans with higher ratings often prioritize preventive care, chronic condition management, and overall wellness. This can lead to better health outcomes for members.
5. Impact on Plan Providers: Medicare Star Ratings incentivize providers to improve their performance. Plans with higher ratings may receive additional bonuses from CMS, which can lead to reinvestment in member benefits and services.

Other things to consider

Although Medicare Star Ratings are essential, they shouldn’t be the only factor anyone’s health coverage decision. Here are some additional considerations:

Plan costs: Enrollees must compare premiums, deductibles, copays, and out-of-pocket maximums.

What the plan covers: It is imperative to be sure the preferred doctors & hospitals are in network as well as coverage of necessary medications.

Individual needs: Although one plan may have a lower rating than another it still may be a better choice for the individual depending on personal preferences and needs.

Use Star Ratings

Licensed Medicare agents can help compare plan options as well as using Medicare’s Plan Finder tool to compare plans and view star ratings. Be sure that details about coverage, costs, and benefits are clear before making a choice.

Medicare counselors, brokers, agents, or state health insurance assistance programs (SHIPs) can help interpret ratings and assist beneficiaries in choosing the best coverage.

Medicare Star Ratings are a way to evaluate quality and performance of Medicare Advantage and Part D plans. Understanding what the ratings mean and how to use them effectively, can help beneficiaries make informed decisions about healthcare coverage.

If you are a Medicare agent and you wan tot join the team at Crowe, click here.

Medicare Part D (prescription drug coverage) is essential for anyone enrolled in Medicare. Additionally, it is equally important that both agents and enrollees understand the Medicare Part D enrollment periods.

IEP (Initial Enrollment Period)

The IEP ( Initial Enrollment Period) is the beneficiaries first opportunity to enroll in Medicare coverage, this includes Part D. IEP is a 7 month window that begins three months before the month the beneficiary turns 65. It includes their birthday month and ends three months after their 65 birthday month.

Individuals who are eligible for Medicare due to disability have an IEP that starts three months before their eligibility date and ends three months after their 25th month of disability benefits.

During this period, beneficiaries can either enroll in a standalone Part D plan or an MAPD (Medicare Advantage plan that includes drug coverage).

AEP (Annual Enrollment Period)

The AEP (Annual Enrollment Period), sometimes referred to as Open Enrollment, takes place annually from October 15 to December 7. During this time, beneficiaries can enroll in a Part D (PDP) plan if they miss their IEP. They can also switch from one Part D plan to another or enroll in an MAPD plan. As long as they have Part D coverage.

Please note: any changes in coverage made during AEP take effect on January 1st of the following year.

MA OEP (Medicare Advantage Open Enrollment Period)

This enrollment period runs from Jan 1 through March 31 each year and is only available to those already enrolled in a Medicare Advantage plan. This provides enrollees an additional opportunity to make changes to their current MA/MAPD plan.

During the MA OEP beneficiaries can change from one Medicare Advantage plan to another Medicare Advantage plan either with or without Part D coverage. They can also disenroll from a Medicare Advantage plan and go back to Original Medicare with the option to enroll in a stand alone Part D plan and a Medicare Supplement. Please note the beneficiary must have a guaranteed issue election or pass underwriting to enroll in a Medicare Supplement plan.

Watch a quick YouTube video on OEP best practices

SEPs (Special Enrollment Periods)

SEPs (Special Enrollment Periods) allow beneficiaries to make changes to Part D coverage outside the standard enrollment windows under specific circumstances, such as:

Losing other creditable drug coverage: If the enrollee loses employer sponsored coverage or their plan is discontinued in their service area, they have 63 days to enroll in a Part D plan after losing coverage.

Moving to a new service area: If the current plan isn’t available in their new location, the enrollee is eligible for an SEP.

Qualifying for Extra Help: Individuals eligible for Medicare’s Extra Help program can change their Part D plan once per calendar quarter during the first three quarters of the year.

LEP (Late Enrollment Penalty)

It’s important for beneficiaries to enroll in Part D coverage when first eligible to avoid the late enrollment penalty. The penalty applies if they go without creditable prescription drug coverage for a period of 63 consecutive days or more once their IEP is over.

The penalty is calculated based on how the beneficiary went without coverage and is added to their monthly premium amount for life.

How to choose the right plan

1. It is imperative to check all medications to see which plan provides the best coverage for them. All plans have their own formulary.
2. Compare the plans that cover the drugs best. Consider all costs for each plan. The cost includes the premium as well as deductibles, copays and coinsurance.
3. Make sure the plan is in network the preferred pharmacy to ensure you get the best price.
4. Because plan costs and coverage changes each year, it is important to review coverage options each year during the AEP.
5. Ask for assistance from a licensed Medicare agent who is appointed with several area carriers to provide the best options for coverage. The medicare.gov tool is a good way to check prices but it cannot answer your specific questions.

Understanding Medicare Part D enrollment periods and rules can save money and ensure you have the coverage you need.

If a client asks what a Medicare Advantage Plan covers, keep reading and get some answers. Medicare Advantage plans, also known as Medicare Part C, provide a comprehensive alternative to Original Medicare. Private insurance companies that are approved by Medicare offer the plans. The plans must cover all services covered by Medicare Part A (hospital insurance) and Part B (medical insurance). Although, Medicare Advantage plans usually provide more than just the basic coverage. Most plans provide additional benefits that make them more attractive to many beneficiaries.

Core benefits

Hospital coverage:

Just like Medicare Part A, Medicare Advantage plans cover inpatient hospital stays, skilled nursing facility care, and hospice care.

Medical Services:

Advantage plans cover the same standard Part B services as Original Medicare. This includes coverage of doctor visits, outpatient medical care, preventive services, and medical equipment.

Additional benefits

Many Medicare Advantage plans include services that Original Medicare doesn’t cover. The items below are not included in all plans as each plan varies by provider, state and exact location.

Prescription Drug Coverage:

Medicare Advantage plans labeled MAPD include prescription drug coverage (Part D) many prescription medications. If the Advantage plan is labeled MA only, it does not include prescription drug coverage.

Vision Services:

Some plans cover routine eye exams as well as some coverage for glasses and contact lenses.

Hearing Services:

Hearing coverage in some plans include hearing exams and a portion of the cost for hearing aids.

Dental Care:

Dental coverage is one of the most popular benefits that is often included in Medicare Advantage Plans. Many plans cover routine dental exams, cleanings, and sometimes restorative dental procedures.

Wellness Programs:

Many plans offer a reimbursement or a free fitness membership as well as other incentives to encourage members to practice healthy living habits.

Other Advantage Plan benefits:

Some plans provide things like; transportation services to and from medical appointments. While others provide OTC benefit cards that members can use for over the counter products, healthy foods or even to help pay utility bills or numerous other items. It is important to remember, each plan offers different benefits.

Plan costs

At present, many Medicare Advantage plans offer low to no cost plan options. Plan enrollees are required to pay a monthly Part B premium in addition to any plan premium they might have. Other costs include deductibles, copays, and coinsurance. The amount of these costs vary depending on the specific plan. Although some plans offer $0 premiums, it’s important to review all out-of-pocket costs.

Plan networks

Medicare Advantage plans use a specific network of providers. In general, there are a few different types of plans, The two main plans are either part of an HMO (Health Maintenance Organization) or PPO (Preferred Provider Organization). Whatever plan a beneficiary considers, they must be sure their doctors and hospitals are part of the plan’s network to avoid paying higher costs.

Limitations and Considerations

Although Medicare Advantage plans may include some great added benefits, beneficiaries need to consider their limitations. Their limitations include the network restriction; if the member needs to use care outside the network, they may pay added fees or even the entire cost of some care.

HMO plans require enrollees to have specialist visits approved by their primary provider before they seek care. This can add to the time it takes to receive treatment. Enrollees may also have trouble seeking care outside their plan’s immediate service area.

If a beneficiary suffers from a serious illness such as cancer; they may have to pay a percentage of the cost of their treatment until they reach their maximum out of pocket.

Choosing the Right Plan

Selecting a Medicare Advantage plan requires careful consideration of the beneficiary’s healthcare needs, budget, and preferred providers. It is essential to understand what is important to each individual and compare plans that provide the closest match to the client’s needs and wants. Licensed insurance agents can be an integral part of finding the best fit for the beneficiary.

If you are an agent who is ready to join the team at Crowe, click here for online contracting.

Medicare Advantage plans are great option for those looking for coverage at a low cost that offers additional benefits. However, it’s essential to understand the details of each plan to ensure it aligns with the healthcare needs and financial situation of each person.

Many Medicare beneficiaries will receive new Medicare cards. This is due to a breach of PII (personally identifiable information) as well as some personal health information. CMS (Centers for Medicare & Medicaid Services) and WPS (Wisconsin Physicians Service Insurance Corporation) are sending out notifications to individuals who’s information may be at risk.

This incident occurred in connection with WPS and the Medicare administrative services they provided for CMS. WPS is a contractor that CMS hired to handle Medicare Part A and B claims and related services. Apparently a specific software application WPS used to transfer files showed a potential risk. This may have caused personal information of Medicare beneficiaries as well as other individuals who use the same providers to be as risk.

What personal information is at risk

Some information that may be at risk due to the incident are:

1. Name
2. Date of birth
3. Social Security number or taxpayer ID
4. Medicare Beneficiary Identifier (MBI)
5. Mailing address
6. Hospital/provider account numbers
7. Health insurance claim number
8. Date of service

Who is receiving the notices

Both CMS and WPS are sending written notices to the 946,801 Medicare beneficiaries who may be affected. The notice lets them know about the breach as well as what they are doing in response.

Additionally; CMS is posting a notice for those who may not receive the written notice due to lack of correct contact information. See below for a sample of the letter WPS is sending:

Dear_______________:

The Centers for Medicare & Medicaid Services (CMS), the federal agency that manages the Medicare program, and Wisconsin Physicians Service Insurance Corporation (WPS), are writing to inform you of an incident involving your personal information related to services provided by WPS. WPS is a CMS contractor that handles certain Medicare claims in your state.

The incident involved a security vulnerability in the MOVEit software, a third-party application used by WPS for the transfer of files during the Medicare claims process. WPS is among the many organizations in the United States that have been impacted by the MOVEit vulnerability.

We are sending you this letter so that you can understand more about this incident, how we are addressing it, and additional steps you can take to further protect your privacy. We are providing information on free credit monitoring with this notice, and we will be giving you a new Medicare card with a new Medicare Number.

Your current Medicare benefits or coverage are not affected as a result of this incident.

What CMS is doing about this

CMS and WPS are working together along with law enforcement agencies and cybersecurity forensic consultants to investigate the incident. CMS is taking all actions necessary to protect the personal information of Medicare beneficiaries.

What Medicare beneficiaries can do

WPS is providing those effected with a free Experian 12 month credit monitoring service. It is a good idea to take advantage of this. Beneficiaries do not provide any form of payment information to enroll in this service.

It is important to take advantage of free credit reporting services. Everyone is entitled to a free report every 12 months from the three major credit reporting agencies:

Request a copy of your credit report: 

Visit the Experian website or call (888) 397-3742

Call TransUnion at (800) 916-8800 

Visit the Equifax website or call (888) 378-4329 

Beneficiaries can also call 1-877-322-8228 or request your free credit reports online at annualcreditreport.com.  Once you receive the report, check for issues or inquiries for new accounts you did not request.

Monitoring credit is a way to detect problems early and address issues quickly. Contact law enforcement about suspicious activity and get a copy of any reports filed to send to creditors as proof. Beneficiaries can also file a report with the FTC either on their website by phone 1-877-idtheft (1-877-438-4338) or by mail Federal Trade Commission, Consumer Response Center, 600 Pennsylvania Ave, NW, Washington, DC 20580.

Medicare Cards

Beneficiaries will continue to use their existing Medicare card. CMS is sending new cards with new MBIs for those who may affected. Once the beneficiary receives the new card, they should follow the instructions that come with the card. The instructions will include when to start using the new card. Beneficiaries should destroy their old card at that time. It is important that they give the new number to their providers to avoid delays in payments.

Learn why using a Medicare agent can be a great idea.   

More Information

Beneficiaries who have questions about this can call the confidential toll-free Experian response line at 833-931-5700. Just provide engagement number B130492, there are professionals familiar with this incident and can advise how to protect yourself from information misuse. Reach the professionals at the response line Monday -Friday 8 am – 8 pm Central Time (excluding major U.S. holidays).

The Medicare Extra Help program, also known as LIS (Low-Income Subsidy), is a valuable resource for Medicare enrollees with limited income and resources. Individuals who qualify have a reduction in the cost of prescription drugs. Extra Help provides an important benefit. It helps lower premiums, deductibles, and copays. The Extra Help income limits 2025 have been increased to keep up with the cost of living. This ensures a greater number of individuals will qualify for the program.

The Extra Help program is available to individuals who:

1. Reside in one of the 50 states or Washington, D.C.
2. Are enrolled in Medicare Parts A and B
3. Are a member of a qualified Medicare Part D plan; either a stand alone or a MAPD plan.
4. Have assets and income at or below the annual limit set by the Department of Health and Human Services.
5. Those enrolled in Medicaid automatically qualify for the program

The Medicare Extra Help Program

The Extra Help/LIS program gives Medicare beneficiaries financial assistance to ensure they can afford their prescription drug costs. The program provides different levels of support level of depending on the income level of the beneficiary.

The levels of Extra Help include Full extra Help and Partial Extra Help. Full Extra Help provides coverage for the most prescription drug costs. This includes plan premiums as well as deductibles and copays. Partial Extra Help gives enrollees who’s income exceeds the threshold by a small margin. These beneficiaries receive reduced financial assistance with premiums and copays.

How to Apply

Individuals who may qualify for the Extra Help program in 2025, can use the following steps to apply: Please note; anyone enrolled in Medicaid is automatically enrolled in the Extra Help program.

Apply online at the Social Security Administration  Beneficiaries can also call Social Security to enroll at 800-772-1213 or TTY: 800-325-0778. Representatives are available to help from 8 am until 7pm CT weekdays M-F. To enroll in person call Social Security and make an appointment at your local Social Security office. Click here to locate your local Social Security office .

Extra Help Income limits 2025

To qualify for LIS/ Extra Help beneficiaries must have income either at or below the threshold set by the Social Security Administration for 2025.

Starting in 2025, the income limit for individuals is $22,590, for married couples, it is $30,660. Asset limits; such as bank accounts, stocks, and bonds must be at or below the resource limits of $16,100 for an individual or $32,130 for married couples.

Here is a list of resources that are considered when applying for Extra Help:

1. Real estate that is not your primary residence.
2. Bank accounts (checking, savings and CDs).
3. Stocks, U.S. Savings Bonds, Mutual Funds.
4. IRAs
5. Cash

What doesn’t count as a resource

1. The beneficiary’s primary residence.
2. Their personal vehicle
3. Any resource that doesn’t easily convert into cash (jewelry or furniture).
4. Rental property used for personal support or land used to grow food for personal consumption.
5. Life insurance or burial expense policies; this includes interest earned on money set aside for burial expenses.

Medicare agents may be able to provide assistance with MSP/LIS applications. In addition, some applicants may qualify for DSNP plans, be sure to check their level of Extra Help and provide assistance to those who qualify for a DSNP plan in your area.

Click here to learn about the SEP Changes for Dual, Partial Dual and LIS members in 2025

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:

1. Lower Premiums: Those who qualify may have a lower or even a $0 premium for their Part D plan depending on the personal finances.
2. Reducing Deductibles and Co-pays: Extra Help lowers out-of-pocket costs for prescription drugs, including deductibles, copays, and coinsurance.
3. 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.
4. 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:

1. Online: Visit the Social Security Administration (SSA) website and complete the application form online.
2. 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.
3. 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.