Takeaways
- People whose income and resources are limited and who have trouble affording the costs of Medicare Part D can benefit from the federal Extra Help Program.
- Some individuals, such as those who also have full Medicaid coverage or receive Supplemental Security Income benefits, qualify for Extra Help automatically.
What Is Extra Help and Who Qualifies?
A low-income subsidy program called Extra Help is available to help pay the premiums, deductibles, and co-payments of the Medicare prescription drug benefit. The amount of the subsidy varies depending on your income.
To qualify for the Extra Help program, you must meet the following criteria:
- Your annual income must be no more than $22,836 for an individual or $30,900 for a married couple living together (in 2025).
- Your resources must be no more than $17,600 for an individual or $35,130 for a married couple living together (in 2025). Resources do not include your home, car, and personal possessions.
You automatically qualify for Extra Help if you are enrolled in Medicaid (you are a “dual eligible” individual), you are enrolled in Medicare Savings Programs (MSPs), or you receive Supplemental Security Income (SSI) benefits.
Depending on your income, you may receive a full or partial subsidy. Medicare will not pay low-income beneficiaries’ premiums for all drug plans, but only those plans that have a premium at or below the “regional benchmark.”
If you are dual eligible, enrolled in MSPs, or get SSI, you do not need to apply for the subsidy. Other individuals have to fill out an application to see whether they qualify for the subsidy. You can go online to apply for Extra Help via the Social Security Administration website or apply by phone; call 1-800-772-1213 (TTY 1-800-325-0778).
Find other helpful information on the Extra Help Program on the Medicare Rights Center's website.
If You Are Enrolled in Both Medicare and Medicaid
Many low-income individuals have health insurance coverage under both Medicare and Medicaid. Medicaid had been covering prescription drugs for these “dual eligibles,” but the law changed that. As of 2006, Medicaid stopped covering prescription drugs.
If dual eligible individuals do not enroll in a prescription drug plan themselves, the U.S. Department of Health and Human Services automatically enrolls them in one. If you had Original Medicare, you will have been enrolled in a stand-alone drug plan whose premium is at or below the standard plan premium in your area. If you had an HMO or PPO, you will have been enrolled in the lowest premium prescription drug plan offered by that company.
If you are a dual eligible, you should make sure that the plan you were assigned covers the drugs you need and the pharmacies you visit. If it doesn't, you will need to choose a different plan. Call 1-800-MEDICARE or go to visit the Medicare website to compare plans.
If you are a dual eligible individual enrolled in a drug plan that stops covering a drug you need, you can change your drug plan once a month. Other beneficiaries are locked into their choice for a full year.
Work With an Elder Law Attorney
Consult with an experienced elder law attorney in your area on questions you may have regarding the Extra Help Program or to seek guidance on other aspects of Medicare.
For additional reading related to covering the costs of Medicare, including prescription medications, check out the following articles:
- Medicare Extra Help Program Expanded in 2024
- Are You Missing Out on Benefits? Find Programs You Can Use
- What Are Medicare Savings Programs?
- Feds Ease Enrollment Process for Medicare Savings Programs
- Medicare Part D Plans 2025: Prescription Drug Coverage
- Pay Monthly for Medicare Part D Prescriptions Come 2025
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