What is Extra Help for Medicare Part D?

Extra Help is a federal assistance program that reduces prescription drug expenses for eligible people with Medicare who have limited income and resources. It is administered by the Social Security Administration in coordination with Medicare.

Medicare Part D provides prescription drug coverage through stand-alone prescription drug plans and Medicare Advantage plans that include drug coverage. Depending on your plan and eligibility, Extra Help can lower the premium, deductible and amount you pay when filling covered prescriptions.

The program can also protect eligible beneficiaries from the Medicare Part D late enrollment penalty while they receive Extra Help. It does not replace Medicare coverage. You still need appropriate Medicare drug coverage to use the benefits for covered prescriptions.

Extra Help income limits for 2026

For 2026, Medicare lists the following standard annual income and resource limits for Extra Help. Income limits are higher in Alaska and Hawaii. The Social Security Administration reviews your circumstances and determines which income and resources count under program rules.

These are the standard 2026 limits published by Medicare. Alaska and Hawaii have higher income limits. Eligibility depends on countable income, countable resources and the circumstances considered by Social Security.

Your income may include Social Security benefits, pensions, wages and other payments under the applicable rules. Certain income exclusions may apply, so your total income is not necessarily the same as the amount counted for eligibility.

If your income is slightly above the listed amount, do not automatically assume you cannot qualify. Special circumstances, household arrangements and allowable exclusions may affect the result. Review the official application guidance or contact Social Security for an individual determination.

What counts as resources for Extra Help?

Resources are assets that may be available to pay expenses. The Social Security Administration applies specific rules to decide which assets count toward the Extra Help resource limit.

The examples above are general guidance, not a complete list. How retirement accounts and other assets are treated can depend on the applicable rules and your situation. Report information accurately on your application and follow Social Security instructions if additional documents are requested.

Who qualifies for Medicare Extra Help in 2026?

You may qualify for Extra Help if you have Medicare, live in one of the 50 states or the District of Columbia, and meet the applicable income and resource requirements. The standard limits are not the only factors that may matter, so Social Security should review your eligibility.

You may want to apply if you:

• Receive Social Security retirement or disability benefits and have limited income.
• Have Medicare and struggle to afford prescription medication.
• Have limited savings and want to check whether your resources fall within the program limits.
• Are married and want to understand how household income and resources are considered.
• Have recently experienced a change in income or financial circumstances.
• Pay a Part D premium, deductible or copayment that is difficult to manage.

You generally need Medicare drug coverage to receive the prescription cost savings. If you do not have a drug plan when you become eligible for Extra Help, Medicare may automatically enroll you in one so you can access the assistance. You can review the plan and choose another eligible plan if appropriate.

Who gets Extra Help automatically?

Some people do not need to submit a separate Extra Help application because they qualify automatically under certain program rules.

• People who receive full-benefit Medicaid coverage.
• People who receive Supplemental Security Income (SSI) payments from Social Security.
• People who receive help from a Medicare Savings Program paying their Medicare Part B premium.

If you qualify automatically, Medicare or Social Security will generally send a notice explaining your Extra Help status and what happens next. If you do not have a Medicare drug plan, you may be automatically enrolled in one. Read the notice carefully and review your plan options.

Receiving Social Security retirement benefits by itself does not automatically mean you qualify for Extra Help. If you do not receive one of the benefits that grants automatic eligibility, you can apply and have your income and resources reviewed.

How much can Extra Help save you in 2026?

The amount of assistance depends on your eligibility, drug plan and prescription needs. Extra Help can reduce several costs associated with Medicare Part D.

If your plan premium is covered in full under the applicable Extra Help benchmark rules, you may pay $0 for that premium. If you choose a plan with a premium above the amount covered, you may need to pay the difference. Check the specific plan before enrolling.

The $12.65 figure is a maximum for covered prescriptions under the applicable 2026 Extra Help cost-sharing rules, not a promise that every prescription will cost that amount. Your cost can be lower depending on the medication and circumstances. Your plans formulary and coverage rules still matter.

How to apply for Extra Help through Social Security

If you are not automatically eligible, you can apply for Extra Help through the Social Security Administration. Applications can be submitted online, and you can also contact Social Security for assistance.

1. Check the official eligibility guidance. Review the income and resource limits on Medicare.gov and Social Security before applying.
2. Gather your financial information. Prepare information about bank accounts, retirement accounts, pensions, tax returns and other income or assets that the application asks about.
3. Open the official Social Security application page. Use the Extra Help application link on SSA.gov rather than an unofficial website.
4. Complete the application accurately. Provide details about yourself, your spouse if applicable, and the income and resources requested.
5. Submit the application and respond to requests. Social Security may contact you if it needs additional information to decide eligibility.
6. Review your decision notice. If approved, check the effective period, drug plan arrangements and instructions for receiving your savings.

Documents to prepare before applying

You may not need to submit every document listed below, but having financial information ready can make it easier to complete the application and answer follow-up questions.

Do not delay an application solely because you are unsure whether a particular asset counts. Use the official application instructions, report the requested information and ask Social Security if you need help understanding a question.

Can you apply for Extra Help and a Medicare Savings Program together?

Yes. Extra Help focuses on Medicare Part D prescription drug costs. Medicare Savings Programs help eligible people pay certain Medicare Part A or Part B premiums and, under QMB, certain Medicare-covered deductibles, coinsurance and copayments.

You can apply for Extra Help and a Medicare Savings Program at the same time. The Extra Help application process can send information to your state to initiate a Medicare Savings Program application, unless you indicate that you do not want that referral. The state agency makes the separate decision about Medicare Savings Program eligibility.

If you receive a Medicare Savings Program that pays your Part B premium, you generally qualify automatically for Extra Help. If you think you may qualify for both, ask Social Security or your state Medicaid agency about applying for both forms of assistance.

What happens after your Extra Help application is approved?

Social Security will send you a notice explaining its decision. If you qualify, Medicare will provide information about your Extra Help status and prescription drug coverage arrangements.

• If you do not have a Medicare drug plan, Medicare may enroll you in one so you can receive your covered prescription savings.
• You can review your assigned plan and choose another plan if you prefer an available option that meets your needs.
• Your drug plan may need proof of your Extra Help status to correct a premium or prescription charge.
• Keep your approval notice and plan documents in case you need to resolve a billing issue.
• Report relevant changes when required and read any notices about your continued eligibility.

If you believe you qualify but are being charged more than expected, contact your prescription drug plan and Medicare. Keep your receipts and explain that you receive, or have applied for, Extra Help. If you are close to running out of medication, tell the plan and Medicare so they can help address the issue promptly.

What if your income or resources are above the limit?

The published limits are important, but they do not tell the entire story for every applicant. Income and resources are counted according to program rules, and some types of income or assets may be excluded. The limits are also higher in Alaska and Hawaii.

If your financial situation has changed, or you are unsure how a pension, retirement account or other payment is treated, review the official rules and consider applying. Social Security can determine which figures count rather than relying on a rough estimate.

If you do not qualify for Extra Help, ask a State Health Insurance Assistance Program (SHIP) counselor about other prescription assistance options, including state pharmaceutical assistance programs where available. You can also compare Medicare drug plans to review premiums, covered medications and pharmacy costs.

Frequently asked questions

Bottom line

Medicare Part D Extra Help can make prescription drug coverage more affordable for eligible people with limited income and resources. For 2026, the standard annual income limits are $23,940 for an individual and $32,460 for a married couple, while the resource limits are $18,090 and $36,100, respectively.

Some people qualify automatically through Medicaid, SSI or a Medicare Savings Program that pays the Part B premium. Others can apply directly through Social Security, and applications are accepted throughout the year.

Check the official 2026 rules, gather your financial information and apply if you think you may qualify. You can also seek free help from a SHIP counselor to understand your options and review Medicare prescription drug plans.