Key Takeaways
Extra Help is a federal program that helps pay for some to most of the out-of-pocket costs of Medicare prescription drug coverage. It is also known as the Part D Low-Income Subsidy (LIS).
Extra Help eligibility
- If your monthly income is up to $1,976 in 2025 ($2,664 for couples) and your assets Assets are resources such as savings and checking accounts, stocks, bonds, mutual funds, retirement accounts, and real estate. are below specified limits, you may be eligible for Extra Help (see the Extra Help income and asset limit chart for details). These limits include a $20 income disregard that the automatically subtracts from your monthly unearned income (e.g., retirement income).Even if your income or assets are above the eligibility limits, you could still qualify for Extra Help because certain types of income and assets may not be counted, in addition to the $20 mentioned above.
- If you are enrolled in Medicaid Medicaid is a federal and state program that provides health coverage for certain people with limited income and assets. , Supplemental Security Income (SSI) Supplemental Security Income is a monthly benefit for people with limited incomes and assets who are 65 or older, blind, or have a disability. , or a Medicare Savings Program (MSP) Medicare Savings Programs (MSPs), also known as Medicare Buy-In programs, help pay your Medicare costs if you have limited income and savings. There are three main MSPs, each with different benefits and eligibility limits: Qualified Medicare Beneficiary (QMB), Specified Low-Income Medicare Beneficiary (SLMB), and Qualifying Individual (QI) program. The Qualified Disabled Working Individual (QDWI) program is a less common MSP for people who are under 65, have a disabling impairment, and continue to work. , you automatically qualify for Extra Help regardless of whether you meet Extra Help’s eligibility requirements. You should receive a purple-colored notice from the Centers for Medicare & Medicaid Services (CMS) informing you that you do not need to apply for Extra Help.
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Contact your local State Health Insurance Assistance Program
Each state offers a SHIP, partly funded by the federal government, to give you free counseling and assistance. A SHIP counselor may be available by phone or in person.
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Contact your local State Health Insurance Assistance Program
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[glossary_exclude]Each state offers a State Health Insurance Assistance Program (SHIP), partly funded by the federal government, to give you free counseling and assistance. A SHIP counselor may be available by phone or in person.[/glossary_exclude]
Visit www.shiptacenter.org to find your local SHIP office.
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Extra Help benefits
The Extra Help program (also called the Part D Low-Income Subsidy) offers the following benefits:
- Pays for your Part D premium up to a state-specific benchmark amount
- Lowers the cost of your prescription drugs
- Gives you a Special Enrollment Period (SEP) once per month to enroll in a stand-alone Part D plan. If you have
Original Medicare
Original Medicare, also known as Traditional Medicare, is the fee-for-service health insurance program offered through the federal government, which pays providers directly for the services you receive. Almost all doctors and hospitals in the U.S. accept Original Medicare.
, you can use this SEP to change your stand-alone Part D plan. If you have a
Medicare Advantage
Medicare Advantage, also known as Part C, Medicare Private Health Plan, or Medicare Managed Care Plan, allows you to get Medicare coverage from a private health plan that contracts with the federal government. All Medicare Advantage Plans must offer at least the same benefits as Original Medicare (Part A and Part B), but can do so with different rules, costs, and coverage restrictions. Plans typically offer Part D drug coverage as part of Medicare Advantage benefits. Medicare Advantage Plans include Health Maintenance Organizations (HMOs), Preferred Provider Organizations (PPOs), Private Fee-for-Service (PFFS) plans, Special Needs Plans (SNPs), and Medicare Medical Savings Accounts (MSAs).
 Plan, you can use this SEP to switch to Original Medicare with a stand-alone Part D plan. You cannot use this SEP to enroll in a Medicare Advantage Plan with drug coverage.
- If you have Medicaid, you have an additional SEP once per month to enroll in an integrated Dual-eligible Special Needs Plan (D-SNP). An integrated D-SNP is a type of Medicare Advantage Plan that meets certain requirements to provide Medicare and Medicaid benefits together.
- Eliminates any Part D late enrollment penalty you may have incurred if you delayed Part D enrollment
Depending on your income and assets, you may qualify for Extra Help. To receive such assistance, your prescriptions should be on your plan’s formulary The formulary is the list of prescription drugs covered by a Part D plan or Medicare Advantage Plan. If your drug is not on the formulary, you may have to request an exception, file an appeal, or pay out of pocket. and you should use pharmacies in your plan’s network A network is a group of doctors, hospitals, and pharmacies that contract with a Medicare Advantage Plan to provide health care services. Generally, plan members will have the lowest costs when using providers and facilities in the plan’s network. Networks may be made up of both preferred and non-preferred providers. .
Remember that Extra Help is not a replacement for Part D or a plan on its own: You must still have a Part D plan to receive Medicare prescription drug coverage and Extra Help assistance. If you do not choose a plan, you will in most cases be automatically enrolled in one.
Making an Extra Help decision when you have other forms of prescription drug coverage
If you are eligible for Extra Help and already have other creditable drug coverage, you should evaluate your costs and coverage when deciding whether to enroll in Part D and Extra Help or to keep your current drug coverage. Be sure to ask your former employer or union if you can get a Part D plan without losing the retiree benefits you want to keep, and check if disenrolling from retiree drug coverage makes you ineligible for other retiree health benefits. If you cannot have Part D and your retiree benefits, or if keeping both is not cost-effective, think carefully about whether you should get a Part D plan, especially if your retiree plan also covers your spouse or dependents. If you later want Part D, you will have a two-month SEP after you lose creditable coverage Creditable coverage is used in two different ways. In general, it is coverage that gives you the right to buy or switch health insurance coverage without penalty, restriction, or waiting period. Different types of health insurance have different creditable coverage requirements. For Medigap policies, certain health insurance coverage you had within 63 days of securing a new policy can be used to shorten the waiting period for pre-existing conditions. This type of coverage that shortens the waiting period would be called creditable coverage. For Part D, creditable coverage is prescription drug coverage that is evaluated by an actuary and determined to be as good as or better than the basic Part D benefit. If you have creditable drug coverage, you can delay enrollment without penalty. Medicare Part A and Part B enrollment is NOT affected by prior creditable coverage. .
Finally, those with Medicaid and certain kinds of employer, union, or retiree drug coverage may in some cases not be enrolled in Extra Help or can ask not to be. Contact your local Medicaid office to learn how to decline Part D without losing your Medicaid coverage. If you later want Part D, you can enroll at any time without penalty if you are still enrolled in Medicaid or eligible for Extra Help.