Are you finding it hard to manage your prescription medication expenses while on Medicare? The Extra Help program, also known as the Low-Income Subsidy (LIS), is a federal initiative designed to assist Medicare beneficiaries with limited income and resources in affording their prescription drugs. This program can significantly lower your out-of-pocket costs for monthly premiums, annual deductibles, and copayments related to your Medicare Part D drug plan.
While the Extra Help program may not eliminate all your medication costs, it can substantially ease the financial burden, making essential medications more accessible and affordable.
Extra Help Works Alongside Other Assistance
If you are already receiving assistance, such as a grant for specific medication costs, Extra Help can provide broader coverage. Unlike grants that are often diagnosis-specific, Extra Help covers prescription medications for any condition. This comprehensive support can be particularly beneficial if you require multiple medications for various health needs.
Understanding the Benefits of Extra Help
The Extra Help program offers extensive financial assistance to those who qualify, potentially covering almost all costs associated with prescription drugs. Individuals who are enrolled in both Medicare and their state’s Medicaid program are automatically enrolled in Extra Help, highlighting the program’s role in supporting vulnerable populations.
In 2025, beneficiaries who qualify for Extra Help will experience significant cost reductions:
- No Deductible: You will not have to meet a deductible before your Part D drug plan starts covering costs.
- No Premiums: You will not pay monthly premiums for your Medicare Part D drug plan.
- Reduced Copays: You will pay no more than $12.15 for each brand-name drug covered by your plan and only $4.90 for generic medications.
These reduced costs can lead to substantial savings throughout the year, making healthcare more affordable and predictable.
Check Your Eligibility for Extra Help
For many, Extra Help enrollment is automatic. You do not need to apply if you meet certain criteria; Medicare will notify you directly about your automatic enrollment in the Extra Help program if you:
- Are dually eligible for both Medicaid and Medicare.
- Receive Supplemental Security Income (SSI) benefits. (Learn about SSI)
- Qualify for a Medicare Savings Program. (Explore Medicare Savings Programs)
If you do not automatically qualify, you can still apply for Extra Help based on your income and resources.
Income and Resource Limits for 2025
To be eligible for Extra Help in 2025, your annual income and total resources must be below specific thresholds. These limits are set at 150 percent of the federal poverty level.
| 2025 Guidelines | 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 family members living with you, you may still qualify for Extra Help even if your income exceeds these amounts.
Note: Resources include funds in checking, savings, and retirement accounts, as well as stocks and bonds. For detailed information on income and resource limits, visit Medicare.gov’s Extra Help page.
It’s worth noting that while Extra Help is not available in Puerto Rico, the U.S. Virgin Islands, Guam, the Northern Mariana Islands, or American Samoa, residents in these territories may find assistance through state Medicaid programs. Learn more about Medicaid services.
Determine Potential Eligibility with Our Tool
To get an initial idea of whether you might be eligible for Extra Help benefits, consider using online eligibility tools.
DISCLAIMER: Please remember that online quizzes are not a substitute for the official application process. Potential eligibility indicated by these tools does not guarantee enrollment in the Extra Help program. Formal application through the Social Security Administration is required to determine official eligibility and enrollment.
Applying for the Extra Help Program
Applying for Extra Help is a free process that requires gathering financial documents and dedicating some time to complete the application. The potential savings, however, make the effort worthwhile.
Mature woman with gray hair sitting in wheelchair smiles slightly
Documents and Information Needed for Application
When completing the application for the Extra Help program with the Social Security Administration, you will need to provide details about 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 online application allows you to save your progress and complete it at your own pace. Assistance from family members, caregivers, or other trusted individuals is permitted and can simplify the application process.
Gathering the necessary documents and understanding what assets you own individually, jointly with your spouse, or with others is crucial for a smooth application. While this preparation may seem daunting, remember the significant financial relief the program offers. Utilize available checklists to organize your documents effectively.
Helpful Resources for Application
- Extra Help Application Guide (PDF): Comprehensive guide to applying for Extra Help
- Extra Help Application Checklist: Organized checklist to prepare your application
Application Timing
You can apply for the Extra Help program once every year, at any point throughout the year. There is no specific enrollment period, allowing you to apply whenever it best suits your circumstances.
Where to Submit Your Application
Ready to apply? Access the application directly through the Social Security Administration website:
Need Application Assistance?
State Health Insurance Assistance Programs (SHIPs) offer free counseling and support to Medicare beneficiaries and their families. This includes assistance with applying for the Extra Help program. Contact SHIP for help by calling toll-free at 877-839-2675 or by visiting their website:
What Happens After You Apply?
You are not required to submit proof of the information provided in your Extra Help application. The Social Security Administration verifies your details by cross-referencing with other government agency databases. Following your application submission, the Social Security Administration will review your information and send you a notification letter within approximately six weeks, informing you of your Extra Help eligibility status.
Maintaining Enrollment in Extra Help
To remain enrolled in the Extra Help program, you must continue to meet the eligibility requirements each year. Staying informed about the annual renewal process and eligibility criteria is important for continuous benefits. Learn more about maintaining your Extra Help benefits from year to year:
Keeping Your Extra Help Benefits
Additional Ways to Reduce Prescription Costs
Strategies for Saving on Medications
If you are concerned about prescription drug costs, numerous strategies and resources are available. Explore various options to lower your out-of-pocket expenses beyond the Extra Help program. Discover practical tips for reducing your medication costs:
Guide to Saving Money on Prescriptions
Financial Assistance Programs for Prescriptions
Financial aid for prescription medications is available from various sources, including federal and state government programs, non-profit organizations, and private sector initiatives. Understand the landscape of patient financial assistance to find additional support:
Patient Financial Assistance Guide
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