Medicare Part D Extra Help: What Agents and Beneficiaries Need to Know
When it comes to Medicare, prescription drug coverage can be a very confusing and expensive component for beneficiaries. Fortunately, there’s a federal program called Extra Help, also known as the Low-Income Subsidy (LIS), that can significantly reduce those costs. As a Medicare agent, you need to be able to answer the question; what’s Medicare part D Extra Help. Understanding and explaining this benefit can be a game-changer for your clients.
What Is Medicare Part D Extra Help
Extra Help is a program administered by the Social Security Administration (SSA) and Centers for Medicare & Medicaid Services (CMS) to assist individuals with limited income and resources in paying for their Medicare Part D prescription drug plan costs. This includes premiums, deductibles, and copayments.
The value of this benefit can be substantial—worth an average of about $5,300 per year (2024 estimate).
Who Qualifies for Extra Help?
To qualify for Extra Help, beneficiaries must meet certain income and resource limits. As of 2025 (these numbers are adjusted annually):
- Income Limits:
- Individuals: Up to $23,715 annually
- Married couples: Up to $31,965 annually
- Resource Limits (includes bank accounts, stocks, and bonds; excludes home, car, personal items):
- Individuals: Up to $17,600
- Married couples: Up to $35,130
Click here for a LIS Extra Help chart for 2025
Note: People who automatically qualify for Extra Help include those who:
- Have full Medicaid coverage
- Receive Supplemental Security Income (SSI)
- Qualify for an MSP (Medicare Savings Program)
What Extra Help Covers
Depending on the level of help a beneficiary qualifies for, Extra Help can:
- Reduce or eliminate monthly Part D premiums
- Lower or remove the annual Part D deductible
- Cap out-of-pocket drug costs
In most cases, those receiving Extra Help will pay:
- Low or no monthly premiums for a benchmark Part D plan
- A small deductible as low as $0
- Low copays (as little as $4.80 for generics and $12.15 for brand-name drugs in 2025) Full-Duals pay $1.60 for generic and $4.80 for brand name drug copays
Watch a quick YouTube video on the Quarterly SEP for Dual and Drug Help Elimination in 2025
How to Apply for Extra Help
- Online at www.ssa.gov/extrahelp
- By calling 1-800-772-1213 (SSA)
- Or by visiting the local Social Security office
As an agent, you can guide clients through the application process, help gather the right documentation, and verify eligibility.
Why Agents Should Care
Helping clients apply for Extra Help not only strengthens your relationship with them but also ensures they can afford necessary medications. When a client qualifies, they may be more willing and able to enroll in or stick with a Part D plan; making this an ideal opportunity to offer value and grow your book of business.
Agents, if you are ready to join the team at Crowe; click here for contracting
SEP for Extra Help Recipients
Don’t forget, beneficiaries who qualify for Extra Help are eligible for a Special Enrollment Period (SEP). This means they have an SEP to change their Medicare Part D plan once they are approved for extra help.
learn about the SEP Changes for Dual, Partial Dual and LIS members in 2025
Extra Help can be life-changing for Medicare beneficiaries who struggle with prescription drug costs. As an agent, your role in identifying eligibility and guiding your clients through the application process is crucial. It’s a win-win: clients get meaningful financial relief, and you build long-term trust and loyalty.