Medicare Extra Help (LIS): Who Qualifies for Lower Drug Costs

Medicare Extra Help, officially the Part D Low-Income Subsidy, is a federal program that helps people with limited income and resources pay for Medicare prescription drug coverage (Medicare.gov). For 2026, the income limit is $23,940 a year for an individual and $32,460 for a married couple, and qualifying beneficiaries pay $0 for their Part D premium and deductible, plus no more than $5.10 per generic drug and $12.65 per brand-name drug (Medicare.gov). Prices and eligibility vary, so it is worth comparing prescription prices even while receiving Extra Help.

Who qualifies for Extra Help in 2026

Eligibility is based on both income and countable resources (assets). For 2026:

These figures come directly from Medicare.gov's 2026 cost table (Medicare.gov) and CMS's official CY2026 resource limits memo, which sets the base full-subsidy resource limit at $16,590 for an individual and $33,100 for a married couple before the burial expense allowance is added (CMS). Limits are slightly higher for residents of Alaska and Hawaii. Since the Inflation Reduction Act's changes took effect in 2024, there is no longer a separate "partial" subsidy tier: everyone who qualifies for Extra Help now receives the full benefit level.

Resources generally include money in checking and savings accounts, stocks, and bonds. Your primary home, one vehicle, personal belongings, and up to $1,500 per person set aside for burial expenses are not counted.

What Extra Help actually covers

According to Medicare.gov, in 2026 Extra Help recipients pay:

• $0 for the Part D plan premium (on a benchmark plan) and $0 annual deductible.
• Up to $5.10 for each generic or preferred multi-source drug.
• Up to $12.65 for each brand-name drug.
• No more than $4.90 per covered drug if you also have full Medicaid and are enrolled in the Qualified Medicare Beneficiary (QMB) program.

Once your total drug costs for the year, including amounts paid on your behalf through Extra Help, reach the annual out-of-pocket cap, you pay $0 for covered drugs for the rest of the calendar year. That cap applies to all Part D enrollees under the current Medicare Part D redesign, though Extra Help recipients typically reach it having paid far less out of pocket than someone without the subsidy.

Automatic enrollment versus applying yourself

You do not need to apply if you already fall into one of these groups, since Medicare and Social Security enroll you automatically:

• You have full Medicaid coverage in addition to Medicare.
• You are enrolled in a Medicare Savings Program that helps pay your Part B premium.
• You receive Supplemental Security Income (SSI) benefits.

If none of those apply to you but your income and resources are within the limits above, you need to submit an application. The Social Security Administration notes that Extra Help is estimated to be worth about $5,700 per year to a typical beneficiary (SSA).

How to apply

You can apply for Extra Help through the Social Security Administration in any of these ways:

• Online at ssa.gov/medicare/part-d-extra-help.
• By phone, calling Social Security at 1-800-772-1213 (TTY 1-800-325-0778), Monday through Friday, 8 a.m. to 7 p.m.
• In person at your local Social Security office.
• Through your state Medicaid agency, which can also help you apply.

You can apply at any time during the year, and approval can take a few weeks to process. If you are denied, you can appeal or reapply if your income or resources change.

Extra Help and comparing prices

Extra Help caps what you pay per prescription, but it does not guarantee that every pharmacy charges the exact same amount before the subsidy is applied, and plan formularies still affect which drugs are covered at which tier. It is still useful to check your plan's formulary tier placement and compare pharmacy prices for any drugs not fully covered by your Part D plan.

Compare prescription prices on BetterBuyRx to see how your Extra Help copay compares with cash prices at nearby pharmacies, particularly for drugs not on your plan's formulary.

What to do if you are close to the limits but not sure you qualify

Because eligibility is based on both income and resources, some people assume they will not qualify when they actually would, especially if a significant portion of their assets is in an excluded category like their home or retirement account rules vary. It costs nothing to apply, and applying does not affect your regular Medicare coverage. If you are unsure, contact Social Security directly or ask a State Health Insurance Assistance Program counselor for a free eligibility review.

Search your medication on BetterBuyRx while you wait for an Extra Help determination, so you know your options at the pharmacy counter in the meantime.

What happens if your income or resources change during the year

Extra Help eligibility is not locked in permanently once approved. If your income or resources increase enough to exceed the limits, you may lose the subsidy at your next annual review, typically conducted by Social Security or your state Medicaid agency. Conversely, if your income drops, you can reapply at any time rather than waiting for a specific enrollment period, unlike standard Part D plan changes, which are generally limited to certain enrollment windows during the year.