Navigating the costs associated with healthcare, especially prescription medications, can be challenging for seniors and individuals with limited incomes. Fortunately, there are programs designed to ease this burden. One such crucial program is known as Extra Help, also referred to as the Low-Income Subsidy (LIS). This federal initiative is specifically designed to assist people with Medicare in managing the expenses related to their prescription drug coverage.
The Extra Help program offers significant financial assistance to those enrolled in Medicare Part D drug plans who meet certain income and resource limitations. While it may not eliminate all out-of-pocket expenses, it can substantially reduce the costs you incur for essential medications.
Mature woman seated in a wheelchair
What are the Benefits of the Extra Help Program?
The Extra Help program is designed to provide comprehensive support, significantly lowering prescription drug costs for eligible individuals. In fact, for those who qualify, Extra Help covers almost all expenses associated with Medicare Part D prescription drug plans. Importantly, individuals who are dually eligible, meaning they qualify for both Medicare and their state’s Medicaid program, are automatically enrolled in Extra Help.
Looking ahead to 2025, the cost savings for Extra Help recipients are considerable:
- No Deductible: You will not have to meet any deductible before your prescription drug coverage begins.
- No Premiums for Part D Drug Plans: You will not be responsible for paying monthly premiums for your Medicare Part D drug plan.
- Reduced Co-pays: You will pay significantly reduced co-pays for your medications, with costs in 2025 set at no more than $12.15 for each brand-name drug covered by your plan and just $4.90 for generic medications.
These substantial reductions can make a life-changing difference for individuals who rely on multiple medications or have significant prescription drug needs.
Do You Qualify for Extra Help? Understanding Eligibility
For many, the question is whether they are eligible for this valuable assistance. Some individuals are automatically enrolled in the Part D Extra Help program. You do not need to apply if you fall into any of these categories; Medicare will automatically notify you about your Extra Help enrollment:
- Dual Enrollment (Medicare and Medicaid): If you are enrolled in both Medicare and Medicaid, you are automatically eligible.
- Supplemental Security Income (SSI) Recipient: Individuals receiving Supplemental Security Income (SSI) benefits also qualify automatically.
- Medicare Savings Program (MSP) Qualification: If you qualify for a Medicare Savings Program, you will also receive Extra Help automatically.
For those not automatically enrolled, eligibility for Extra Help is primarily based on income and resource limits. To qualify, your income must be below 150 percent of the federal poverty level. The resource limits for 2025 are also defined, as shown in the table below:
| 2025 | Income Limit* | Resource Limit** |
|---|---|---|
| Individual | $23,475 | $17,600 |
| Married Couple | $31,725 | $35,130 |
Note: Income limits are higher in Alaska and Hawaii. Importantly, if you or your spouse are employed, or if you support other family members living with you, you may still qualify for Extra Help even if your income exceeds these listed amounts.
**Note:** Resources include assets like money in checking, savings, or retirement accounts, as well as stocks and bonds. It is important to note that Extra Help is not available in Puerto Rico, the U.S. Virgin Islands, Guam, the Northern Mariana Islands, or American Samoa. Residents of these territories may explore assistance options through state Medicaid programs. For detailed information about income and resource limits, and to learn more about Extra Help, you can visit Medicare.gov.
How to Apply for the Extra Help Program
Applying for Extra Help is a straightforward process, although it does require gathering some financial documentation and dedicating time to complete the application. The application itself is free.
When you complete the application for the Extra Help program through the Social Security Administration, you will be asked to provide information regarding your income and resources. If you are married and living with your spouse, you will also need to include their income and resource information.
The Social Security Administration provides an online application portal that allows you to begin the application, save your progress, and return to complete it at your convenience. You can also receive assistance from family members, caregivers, or other trusted individuals to help you with the application process.
Gathering the necessary documents and assessing your assets, both individually and jointly with your spouse or others, may seem daunting. However, the potential savings offered by the program are significant and well worth the effort. To assist you in getting organized, helpful checklists and guides are available.
Helpful Resources for Application:
- Extra Help guide to applying (PDF): A comprehensive guide from the Social Security Administration detailing the application process.
- Extra Help application page with helpful checklist: A dedicated page with a useful checklist to help you prepare your application.
You can apply for the Extra Help program once every year, and applications are accepted throughout the year.
Ready to Apply?
- Apply Now: Link to the official Social Security Administration application page.
Need Application Assistance?
If you require personalized help with your Extra Help application, State Health Insurance Assistance Programs (SHIPs) offer free counseling and support to Medicare beneficiaries and their families. This includes assistance with navigating the Extra Help application process. You can contact SHIP toll-free at 877-839-2675 or visit the SHIP website to find local help.
- Find Help via SHIP: Link to the SHIP website to locate assistance in your area.
What Happens After You Apply?
You are not required to submit proof of the information you provide in your Extra Help application. The Social Security Administration will verify your information by cross-referencing it with data from other government agencies to ensure accuracy. Following your application submission, the Social Security Administration will review your information and send you a letter within approximately six weeks to inform you of their decision regarding your Extra Help eligibility.
Maintaining Your Enrollment in Extra Help
To remain enrolled in the Extra Help program, you must continue to meet the eligibility requirements each year. It’s important to understand the guidelines for maintaining your Extra Help benefits from year to year.
- Learn about keeping Extra Help: A resource providing information on maintaining continuous enrollment in the Extra Help program.
Explore Other Ways to Reduce Prescription Costs
Beyond the Extra Help program, there are additional strategies and resources available to help lower your out-of-pocket prescription medication expenses.
Tips for Saving on Prescriptions
If you are concerned about the affordability of your medications, various options can help reduce your costs.
- Guide to saving money on prescriptions: Explore practical tips and strategies to lower your prescription drug costs.
Financial Assistance Options
Financial assistance for prescription medications is available from a range of sources, including government programs, non-profit organizations, and private sector initiatives.
- Guide to patient financial assistance: Learn about different types of financial assistance programs that can help with medication costs.
Expand Your Medicare Knowledge
To further enhance your understanding of Medicare and related resources, explore comprehensive educational materials.
- Medicare Education Resources Hub: Access a central hub of resources to learn more about Medicare and related programs.
