If prescriptions eat up too much of your monthly budget, Extra Help may be the most valuable Medicare benefit you have not heard of. It is run by Medicare and the Social Security Administration, it does not cost anything to apply, and it works alongside a Medicare Part D drug plan. Here is what it does and who qualifies.
What Extra Help actually does
Extra Help pays part of your Part D costs. According to Medicare.gov, the cost-sharing listed for 2027 is:
- No plan deductible and no premium (for plans at or below a benchmark amount; some plans cost more).
- Copays of up to $5.80 for a generic drug and up to $14.40 for a brand-name drug.
- Once total drug costs reach $2,400, no copay for each covered drug.
- No more than $4.90 per covered drug if you have full Medicaid and QMB.
Your actual amounts depend on which Extra Help level you get. It only reduces drug costs. It does not change your Part B premium or what you pay for doctor visits. For more on how drug plans are priced, see what Part D actually costs.
Who qualifies?
Medicare.gov lists these 2026 limits, which can rise each year (Alaska and Hawaii differ):
| Household | Income limit | Resource limit |
|---|---|---|
| Individual | $23,940 | $18,090 |
| Married couple | $32,460 | $36,100 |
How to apply
You apply through the Social Security Administration at ssa.gov. Have your income and savings information ready. If you are approved, you generally keep your current drug plan or can choose one that fits your medications. Because Extra Help only works with a Part D plan, you must be enrolled in one, either stand-alone or inside a Medicare Advantage plan with drug coverage. Learn more on our Medicaid and dual eligible page.
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Get my plan reviewCommon myths about Extra Help
- "I own a home, so I cannot qualify." Resource limits are about savings and similar assets, and Social Security describes them on its application page. Your decision should not rest on a guess, so apply or ask before ruling yourself out.
- "It replaces my drug plan." It does not. Extra Help sits on top of a Part D plan, so you still need to be enrolled in one.
- "It is only for people who are retired." Eligibility is based on Medicare enrollment, income and resources, not on whether you have stopped working.
- "Applying could cost me something." There is no fee to apply. The worst case is that you are told you do not qualify.
What to do if you are approved
First, look at your current drug plan. Extra Help lowers your cost-sharing, but a plan that does not cover one of your medications, or that excludes your pharmacy, can still cause problems. Check that each of your prescriptions is on the plan's drug list and note any prior authorization or step therapy rules. Second, keep your records: approval letters from Social Security or your state are worth saving. Third, remember that your eligibility can be reviewed, so open and read mail from Medicare, Social Security and your state Medicaid office rather than setting it aside.
Extra Help and changing plans
Medicare.gov says that people with Extra Help or Medicaid may be able to change drug coverage once per month. Because the details can depend on your plan type and circumstances, confirm before you cancel anything. Calling 1-800-MEDICARE or our office first keeps you from ending up with a gap in drug coverage, which can trigger a penalty later.
Why a plan review still matters
Extra Help lowers what you pay, but it does not make every plan equal. Plans differ in which drugs they cover, which pharmacies are preferred, and which medications need prior approval. Medicare plans also change every year, so Annual Enrollment (October 15 to December 7) is a good time to recheck your drug list. If you also see the Annual Notice of Change from your plan, our guide on reading your ANOC can help. Missing Part D when first eligible can add a penalty, which we cover in this late enrollment penalty article.
Extra Help in your state
Extra Help is a federal program, so the income and resource limits above apply nationally (except Alaska and Hawaii). Medicaid, Medicare Savings Programs and the plans available to you do vary by state and county, and we have not verified state-specific details for this article. We serve these states, and you can reach us at (571) 354-0146 or through our contact form.
- Virginia: rules vary by state, call us for what applies.
- Maryland: rules vary by state, call us for what applies.
- North Carolina: rules vary by state, call us for what applies.
- South Carolina: rules vary by state, call us for what applies.
- Georgia: rules vary by state, call us for what applies.
- Alabama: rules vary by state, call us for what applies.
- Louisiana: rules vary by state, call us for what applies.
- Texas: rules vary by state, call us for what applies.
- Michigan: rules vary by state, call us for what applies.
- Indiana: rules vary by state, call us for what applies.
- West Virginia: rules vary by state, call us for what applies.
Honorbrook is an independent agency, and our help is free to you. We do not offer every plan available in your area; for all options visit Medicare.gov or call 1-800-MEDICARE.