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Between premiums, deductibles, and coinsurance, paying for prescription medications under Medicare Part D can be very expensive. Even with the new $2,000 limit on out-of-pocket costs and the option to spread payments throughout the year, many Medicare beneficiaries may still struggle to afford their medications.

But Medicare Extra Help can help lower prescription medication costs even further. Here are the requirements and who's eligible for the Extra Help program.

What is the Medicare Extra Help program?

Medicare Extra Help, also called Low-Income Subsidy, is a federal program. It reduces Medicare Part D prescription medication costs for people with limited income and resources. If you qualify for Extra Help, you'll pay no monthly premium for Medicare Part D, have no deductible, and save significantly on your prescription medication copays.

Who qualifies for Medicare Extra Help?

You qualify and are automatically enrolled in Extra Help if you have:

• Both Medicare and full Medicaid, known as dual eligibility

• Assistance paying Medicare Part B premiums through your state's Medicare Savings Program (MSP)

• Supplemental Security Income (SSI) benefits from the Social Security Administration (SSA)

If you're enrolled, you'll receive a letter from Medicare confirming your eligibility and providing information about your coverage. Your Extra Help benefits continue through December 31 of the same year, even if your income changes.

If you don't automatically qualify, you must apply for Extra Help. Eligibility is based on your income and resources, and you must live in one of the 50 states or Washington, D.C. Extra Help is not available in Puerto Rico, the U.S. Virgin Islands, Guam, the Northern Mariana Islands, and American Samoa.

What are the income limits for Medicare Extra Help?

Medicare Extra Help's income limits are based on the previous year's earnings. For example, if you're applying in 2025, the program will look at your 2024 income. Your assets must also be below certain limits to qualify. This chart shows the income and asset limits and what counts and doesn't count toward those limits:

If you expect to use some of your resources for burial expenses, the resource limits are higher. In 2025, they will be $17,600 for an individual and $35,130 for a married couple.

Income and resource limits may change every year. Even if you previously were not eligible for Extra Help benefits, you can reapply if your income or resources change.

What are the benefits of enrolling in Medicare Extra Help?

If prescription medication expenses are draining your budget, Medicare Extra Help has many benefits:

• Covers Medicare Part D costs: Extra Help pays your Medicare prescription plan expenses. This includes your monthly Part D premiums, annual deductible, and coinsurance.

• Lowers prescription medication expenses: With Extra Help, the cost of your covered prescription medications is also reduced. Most people who receive Extra Help pay a set copay for generic and brand-name prescription medications.

• Offers a special enrollment period: Medicare prescription plan members can join or switch plans only during the open enrollment period, which is October 15 to December 7. But starting in 2025, those enrolled in Extra Help can change their coverage once a month. This includes switching to original Medicare with a prescription medication plan or choosing a different prescription medication plan.

• Eliminates Part D late enrollment penalty: If you did not enroll in a Medicare Part D prescription plan when you were first eligible, Medicare applies a lifelong premium penalty. With Extra Help, this late enrollment penalty generally does not apply. But the penalty may apply later if you lose Extra Help eligibility and have gaps in coverage.

How much will I pay with Medicare Extra Help?

In 2025, those who qualify for Extra Help will pay:

• No monthly premiums for their Medicare Part D prescription medication plan

• No Medicare Part D deductible

• No more than $12.15 copay for each covered brand-name prescription medication and no more than $4.90 for generic medications

People with Medicare and Medicaid (dual-eligible beneficiaries) who have an income less than or equal to 100% of the federal poverty level and who meet Extra Help requirements pay no more than $4.80 for brand-name prescription medications and no more than $1.60 for generics.

Dual-eligible beneficiaries who are institutionalized or receiving home- and community-based services and who qualify for Extra Help will have no copay for generic or brand-name prescription medications.

Will I keep receiving Medicare Extra Help every year?

To receive Extra Help each year, you must continue to meet eligibility requirements. In some cases, you'll automatically keep receiving your Extra Help benefits.

For example, if you originally qualified for Extra Help through dual eligibility (Medicare and Medicaid), SSI, or MSP, and you're still eligible for any of those programs in the fall, your state will generally inform Medicare. This means your Extra Help continues automatically, and you don't need to take action. Medicare will send you a letter only if you lose your Extra Help eligibility or if your plan changes.

In other cases, you must apply to renew your Extra Help benefits. These include:

• If you no longer qualify for Medicaid, SSI, or MSP coverage in the fall, you must apply for Extra Help to avoid losing these benefits. You'll receive a letter explaining that your Extra Help benefits will end, along with an application to complete.

• If you originally became eligible for Extra Help because you submitted an application, SSA may request updated financial information. SSA uses the information you provide to determine if you still qualify for Extra Help.

If you disagree with a decision about your Extra Help eligibility, you have the right to appeal.

How to apply for Medicare Extra Help

If you don't automatically qualify for Extra Help, there are a few ways to apply:

• Complete an application through Social Security online.

• Call 1-800-772-1213 (TTY users can call 1-800-325-0778) to apply over the phone.

• Contact your State Health Insurance Assistance Program for application help.

When applying for Extra Help, you'll need to provide income and resource information. Be prepared to share your total monthly income amounts from the following sources:

• Social Security benefits

• Pensions

• Wages

• Alimony

• Net business earnings

• Other income, such as unemployment and disability payments

Know the value of the assets you own, such as:

• Bank accounts (checking, savings, certificates of deposit)

• Investment accounts (stocks, bonds, mutual funds, individual retirement accounts)

• Cash you have at home or stored elsewhere

• Real estate other than your home

Do not count your primary home, vehicles, burial plots, life insurance policies, or personal possessions.

SSA will review your application and notify you of your eligibility status by mail. If you qualify, Medicare will sign you up for a Part D prescription plan if you don't have one. You can choose a different Part D plan anytime if you prefer.

If you need more information about Medicare Extra Help, visit medicare.gov/extrahelp or call Medicare at 1-800-633-4227 (TTY users can call 1-877-486-2048).

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