Navigating the costs of prescription medications can be challenging, especially for those on Medicare with limited incomes. Fortunately, there’s a federal program designed to ease this burden: the Extra Help program, also known as the Low-Income Subsidy (LIS). This program significantly reduces out-of-pocket expenses for prescription drugs for eligible Medicare beneficiaries. While it might not eliminate all costs, enrolling in Extra Help can make a substantial difference in what you pay for essential medications.
Understanding Extra Help and How It Complements Other Assistance
If you’re already benefiting from a patient assistance program for a specific condition, such as a PAN grant, understanding Extra Help is still crucial. While programs like PAN grants are diagnosis-specific, Extra Help provides broader coverage for prescription medications needed for any health condition. This comprehensive approach can be particularly beneficial if you manage multiple health issues and require various medications. By enrolling in Extra Help, you can dramatically lower your overall prescription drug costs, regardless of the condition the medication treats.
Discover the Extra Help Program in Detail
Watch our video explaining the Extra Help program
What are the Benefits of the Extra Help Program?
The Extra Help program is designed to substantially reduce prescription drug costs for those who qualify. For eligible individuals, the program covers a significant portion of expenses, making medications much more affordable. In some cases, those who qualify for both Medicare and their state’s Medicaid program are automatically enrolled in Extra Help, highlighting its importance for vulnerable populations.
Looking ahead to 2025, the benefits for Extra Help recipients are considerable:
- No Deductible: You will not have to meet a deductible before your prescription drug coverage starts.
- No Premiums for Part D Drug Plans: You will not pay monthly premiums for your Medicare Part D drug plan.
- Reduced Copays: You will pay significantly less for covered medications, with costs capped at no more than $12.15 for each brand-name drug and $4.90 for generic medications covered by your plan in 2025.
These substantial reductions in costs can make a significant difference in affording necessary medications.
Am I Eligible for the Extra Help Program?
For many, eligibility for Extra Help is automatic. You don’t need to apply if you meet certain criteria, as Medicare will send you a notification letter about your automatic enrollment. You are automatically enrolled in Extra Help if you fall into any of these categories:
- Dual Enrollment (Medicare and Medicaid): If you are enrolled in both Medicare and Medicaid, you automatically qualify for Extra Help.
- Supplemental Security Income (SSI) Recipient: Individuals receiving Supplemental Security Income (SSI) also automatically qualify.
- Medicare Savings Program (MSP) Qualification: If you qualify for a Medicare Savings Program, you are also eligible for Extra Help.
If you don’t automatically qualify through these categories, you may still be eligible based on your income and resources.
Income and Resource Limits for Extra Help
To determine eligibility based on income and resources, the Extra Help program uses thresholds set annually. For 2025, to qualify for Extra Help, your income and resources must be below the following limits:
| 2025: | Income Limit* | Resource Limit** |
|---|---|---|
| Individual | $23,475 | $17,600 |
| Married Couple | $31,725 | $35,130 |
Important Notes:
- These figures are subject to change each year.
- Extra Help is not available in Puerto Rico, the U.S. Virgin Islands, Guam, the Northern Mariana Islands, or American Samoa. However, residents in these territories may find assistance through state Medicaid programs.
- * Income Limit Considerations: Income limits are higher in Alaska and Hawaii. Additionally, if you or your spouse are employed, or if you support other family members living with you, you might still qualify for Extra Help even if your income exceeds the stated limits.
- ** Resource Limit Details: Resources include assets like money in checking, savings, or retirement accounts, as well as stocks and bonds. For detailed information on income and resource limits, you can visit Medicare.gov’s Extra Help page.
Check Your Potential Eligibility
Find out if you might be eligible for benefits using our tool:
Disclaimer: This eligibility quiz is for informational purposes only and does not replace the official application process. Individuals who appear eligible must still apply through the Social Security Administration to formally determine eligibility and enroll in the Extra Help program. Eligibility through this tool does not guarantee enrollment.
How to Apply for the Extra Help Program
Applying for Extra Help is a free process, although it requires gathering financial documents and dedicating some time to complete the application. The potential savings on prescription costs make the effort worthwhile.
Mature woman seated in a wheelchair, smiling slightly, in a bright indoor setting.
What Information Do You Need to Apply?
When completing the application for the Extra Help program through 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. Family members, caregivers, or other trusted individuals can assist you with filling out the application.
To accurately answer the application questions, it’s necessary to collect relevant documents and assess your assets, considering what you own individually, jointly with your spouse, or with others. While this preparation might seem extensive, remember the significant financial benefits the Extra Help program offers.
Helpful Resources for Application Preparation:
- Extra Help guide to applying (pdf) – A comprehensive guide from the Social Security Administration.
- Extra Help application checklist – A checklist to help you organize the necessary information.
When and Where to Apply
You can apply for the Extra Help program annually at any point throughout the year.
Apply now through the Social Security Administration website.
Get Application Assistance
If you need personalized help with your application, State Health Insurance Assistance Programs (SHIPs) offer free counseling and assistance to Medicare beneficiaries and their families. This includes support with applying for the Extra Help program. You can reach SHIP by calling toll-free at 877-839-2675 or by visiting the SHIP website.
Find local help through the SHIP program.
What Happens After You Apply?
You are not required to submit proof of the information provided in your Extra Help application initially. The Social Security Administration will verify your details by cross-referencing with data from other government agencies. Typically, you will receive a decision letter from the Social Security Administration within six weeks of applying, informing you whether you qualify for Extra Help.
Maintaining Your Enrollment
To remain enrolled in the Extra Help program, you must continue to meet the eligibility requirements each year. It’s important to understand the rules for ongoing eligibility to ensure you continue receiving these valuable benefits. For more information on maintaining your enrollment, refer to resources like Medicare Interactive’s guide on keeping Extra Help.
Additional Ways to Reduce Prescription Costs
Tips for Saving Money on Prescriptions
Beyond the Extra Help program, various strategies and resources can help lower your prescription medication expenses. If you’re concerned about medication costs, exploring these options can be beneficial. Explore our guide to ways you can lower your prescription costs.
Financial Assistance Options
Financial assistance for prescription medications is available from diverse sources, including federal and state government programs, non-profit organizations, and private sector initiatives. Read our guide to patient financial assistance to discover available programs and how to access them.
Expand Your Medicare Knowledge
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