Medicare Part D Extra Help Program

If you are enrolled in Medicare and you have a low income, you can apply to the Medicare Part D Extra Help program. Extra Help is the name of a Medicare program that can help you pay for all or part of your premiums, all or part of your annual deductible, and lower the co-pays on your prescriptions. It is also called the Medicare Low Income Subsidy (LIS).

You can get a full subsidy, which pays for most of your costs. A partial subsidy pays for some of your costs. These subsidies are based on your income and resources.  

You may qualify for the full Extra Help Program if your yearly income and resources are below these limits:

• Single person: Income less than $20,385 and resources less than $15,510
   
• Married person living with a spouse and no other dependents: Income less than $27,465 and resources less than $30,950

If you are below the limit for only one of the factors (income or resources), you can’t get full help, but you might be able to get some help. You should still apply.

Things that are not counted as resources include your home, car, household items, burial plots, money set aside to pre-pay burial expenses and burial space items up to $1,500 per person, or life insurance policies.

The income and resource guidelines change every year. The income numbers in this fact sheet are for 2022. New numbers come out in the spring of 2023. The best place to find the newest guidelines is on the web at www.medicare.gov or https://www.ssa.gov/medicare/part-d-extra-help. Or call 1-800-MEDICARE.

Note: a deductible is the amount you have to pay out of pocket before your Medicare Part D prescription drug plan steps in and helps out.

If you get a Full Subsidy

• Extra Help pays for premiums (your plan’s premiums must be lower than the “benchmark” premium which is $39.87 per month in 2023)

• you do not have a deductible

• your prescription co-pays are $3.95 for generic drugs or $9.85 for brand names

• there is no coverage gap

If you get a Partial Subsidy

• you pay only part of the premium on a sliding scale

• your deductible is not more than $99.00

• your co-pay is 15% until your drug costs total up to $7,050, then your co-pay is between $3.95 (generic drugs) to $9.85 (brand name drugs) or 5% of the drug cost, whichever is greater.

Some people automatically get Extra Help. If you are on Medicare Part D now and are in one of the following groups, you should already be signed up for the Extra Help program:

• Dual Eligibles. This means that you get Medicare Part A and/or Part B and you also get some Medical Assistance.

• On a Medicare Savings Program (QMB, SLMB, QI). See our fact sheet Medicare Savings Programs.

• Getting SSI

If you are in 1 of these groups and are NOT getting Extra Help, contact the Social Security Administration and apply right away.

You can also get Extra Help if you are on Medicare Part D now and meet the income eligibility rules.

You can apply for Extra Help any time. Apply through the Social Security Administration or the State Medicaid office.  

You can apply by phone or have an application mailed to you.

Call: 1-800-772-1213

TTY 1-800-325-0778

To apply online go to: ssa.gov/extrahelp/