Medicare Extra Help: What the Program Pays and Who Qualifies in 2026
If you have Medicare and limited income and resources, Medicare Extra Help — officially the Part D low-income subsidy (LIS) — can lower what you pay for prescription drug coverage. It can help with a Part D plan premium, deductible, and covered prescription copays, subject to Medicare's plan and program rules.
This guide covers the official 2026 income and resource figures, how countable income and resources are reviewed, automatic eligibility groups, application steps, and the Special Enrollment Period rules that may apply.
What Is Medicare Extra Help?
Extra Help is a federal assistance program administered through Social Security and Medicare that helps with the costs of a Medicare Part D drug plan for people who meet the program's income and resource rules. Depending on the plan and your circumstances, it can provide:
- Help with the premium for a benchmark or assigned Part D plan
- A $0 deductible under the full benefit
- Lower, capped copays for covered prescriptions
- Protection from a Part D late-enrollment penalty while you qualify
Extra Help works with Original Medicare and a standalone Part D plan, or with a Medicare Advantage plan that includes prescription drug coverage. You need qualifying drug coverage to use Extra Help.
What Extra Help Pays For in 2026
Premiums and Deductibles
Medicare may assign a benchmark Part D plan with a $0 premium and deductible for someone receiving Extra Help. The plan you select may cost more even when the assigned plan has a $0 premium and deductible, and you may owe the difference or other plan costs. There is no universal $0-premium promise, so check the plan's details before enrolling.
Copay Caps in 2026
Under the full Extra Help benefit, covered prescription costs in 2026 are generally capped at:
- Up to $5.10 for each generic drug
- Up to $12.65 for each brand-name drug
- $0 after reaching Medicare's catastrophic coverage threshold for covered drugs
- $0 copays in some circumstances for people who also have full Medicaid and live in an institution
The CMS 2026 Extra Help publication explains these costs and the plan choices that can affect what you pay.
Extra Help Income Limits for 2026
Medicare.gov lists annual 2026 reference amounts of $23,940 for one person and $32,460 for a married couple for income, and $18,090 and $36,100 for resources. These figures are not a universal eligibility formula.
Income Limits
These income reference figures apply to the 48 contiguous states and the District of Columbia. Alaska and Hawaii have higher federal poverty levels. SSA guidance explains that the applicable income limit also depends on household size, so other household sizes and circumstances can produce different amounts.
Social Security reviews countable income, not simply gross income. Exclusions may apply to earned and unearned income, depending on the type of income and your circumstances; for example, in-kind support and maintenance do not count as income for Extra Help. Do not use a fixed subtraction or the published figures alone to decide whether you qualify. See the SSA POMS income guidance and apply for an official determination.
Resource Limits
Medicare.gov's published 2026 resource reference amounts are:
- $18,090 for one person
- $36,100 for a married couple
Up to $1,500 per person may be excluded when it is set aside for burial under SSA rules. This burial exclusion is conditional, not a general extra deduction: do not add it to the published resource amounts or count the same funds twice.
What SSA May Review as Resources
SSA may review items such as:
- Money in checking, savings, and retirement accounts
- Stocks, bonds, mutual funds, and other investments
- Cash held at home or elsewhere
Some property may be excluded under program rules, such as the home you live in, one vehicle, and household or personal belongings. Exclusions and exceptions vary, so ask SSA rather than assuming that an item is automatically counted or excluded.
Who Qualifies Automatically
Medicare generally identifies you for Extra Help without a separate application if you:
- Have both Medicare and full Medicaid coverage
- Are enrolled in a Medicare Savings Program that pays your Part B premium
- Receive Supplemental Security Income (SSI) benefits
Medicare sends people in these automatic groups a notice. Read it and check your current drug coverage; automatic eligibility does not mean every plan has a $0 premium. Our guide to Medicare Savings Programs explains the Part B premium-help programs.
| Your situation | Next step |
|---|---|
| Already qualifying for an automatic benefit | Check your Medicare notice and current drug coverage. |
| Not automatic or unsure | Review the SSA Extra Help information and apply if appropriate. |
| Need help | Contact a free local SHIP counselor. |
How to Apply for Extra Help
If you are not in an automatic group, use the Social Security Administration's Medicare Part D Extra Help page to apply. You can apply at any time, before or after enrolling in Part D. You need qualifying drug coverage to use Extra Help.
- Apply online through the official Social Security page
- Call Social Security at 1-800-772-1213 (TTY 1-800-325-0778) if you need another application option
- Ask Social Security about an in-person office option if that works better for you
Before applying, review recent bank, tax, retirement, pension, and benefit statements so you can report the information SSA requests. If SSA asks for documents, follow that request; do not assume documents will never be needed.
What Happens After You Apply
Social Security sends a determination notice. Timing, the effective date, and any next steps depend on SSA's review and the notice you receive, so this guide does not promise a decision date or a fixed start date. Keep the notice and follow its instructions. This website provides general guidance, not an eligibility determination.
Choosing a Drug Plan Once You Have Extra Help
If you qualify for Extra Help or Medicaid, Medicare's Special Enrollment Period rules generally allow one change per calendar month for a standalone Part D plan. The SEP can also let you leave a Medicare Advantage plan with drug coverage (MA-PD) by joining a standalone Part D plan; doing so returns your health coverage to Original Medicare. Coverage generally starts the first day of the next month. This is not unrestricted monthly Medicare Advantage switching.
- Compare the selected plan's premium, deductible, copays, formulary, and pharmacy network
- Remember that the selected plan may cost more even when an assigned plan has a $0 premium and deductible
- Read Medicare's rules and your plan notice before making a change
This SEP is not available if you are identified as at-risk or potentially at-risk under a Part D drug management program. Your plan will send a notice. Read it and contact Medicare or a SHIP counselor before changing coverage.
Other Savings Programs That Stack with Extra Help
Extra Help focuses on prescription costs. Medicare Savings Programs can help with Medicare costs separately:
- Medicare Savings Programs can pay the Part B premium — see our MSP income limits guide
- At the QMB level, Medicare cost-sharing protections can also apply — read our QMB guide
- The SLMB tier pays the Part B premium and is an automatic Extra Help group — see our SLMB guide
These programs have their own applications and rules. A SHIP counselor can help you compare the programs without charging for counseling.
Frequently Asked Questions
What are the 2026 income and resource limits for Medicare Extra Help?
For 2026, Medicare.gov lists annual income amounts of $23,940 for one person and $32,460 for a married couple, with resource amounts of $18,090 and $36,100. These are reference figures, not a universal eligibility formula: household size, state, countable income, exclusions, and other rules can affect a determination.
How does Social Security count income for Extra Help?
Social Security evaluates countable income rather than simply gross income. Exclusions may apply, and the rules can depend on income type, household size, and state, so the published figures do not by themselves determine eligibility.
How do I apply for Medicare Extra Help?
Apply through Social Security at any time, before or after enrolling in Part D. Review information in your bank, tax, retirement, pension, and benefit statements, follow any document requests, and keep the determination notice; you need qualifying drug coverage to use Extra Help.
What documents might I need for an Extra Help application?
Review recent bank, tax, retirement, pension, and benefit statements. Social Security may request documents, so follow its instructions rather than assuming no documents will be needed, and keep the determination notice.
Official Sources and Review
Reviewed (Pacific Time). This is general information, not a determination by Social Security or Medicare.
Extra Help is a Part D subsidy. Review your official notice, use the Social Security application when appropriate, and contact a free local SHIP counselor if you want help understanding your options.