Extra Help Medicare 2026: Limits, Copays, and How to Apply

Extra Help Medicare is the program that pays most of your Part D prescription drug costs if your income and savings are limited.

In 2026 it removes your plan premium and deductible and caps what you pay per prescription. Medicare also calls the Extra Help program the Part D Low-Income Subsidy, or LIS. About 13.6 million people have it this year.

This guide gives you the verified 2026 income and resource limits, the exact copays, the three ways people are enrolled automatically, the application steps for everyone else, and what changes on January 1, 2027.

Every dollar figure comes from CMS, Medicare.gov, or Social Security’s own rules, and the enrollment counts from KFF and GAO, all checked on the verification date shown at the top of this page.

Key Takeaways

• 2026 income limits are $23,940 for a single person and $32,460 for a couple, which is 150% of the poverty level. Resource limits are $18,090 and $36,100 counting the $1,500 per person burial allowance, per the CMS memo of October 31, 2025.
• With Extra Help you pay $0 premium up to your region’s benchmark, $0 deductible, and no more than $5.10 per generic or $12.65 per brand-name drug in 2026.
• Full Medicaid, a Medicare Savings Program, or SSI enrolls you automatically. Everyone else applies free at SSA.gov or by calling 1-800-772-1213.
• Once approved, you keep the subsidy through December 31 even if your income rises, and you can change Part D plans once a calendar month.
• For 2027, CMS has already set the copays at $5.80 and $14.40, the Part D deductible at $700, and the out-of-pocket cap at $2,400.

What is Extra Help for Medicare Part D?

Extra Help is a federal Medicare program, formally the Part D Low-Income Subsidy, that pays most prescription drug plan costs for people with limited income and resources.

In 2026 it covers your Part D premium up to a regional benchmark, wipes out the $615 standard deductible, and limits copays to $5.10 for generic drugs and $12.65 for brand-name drugs.

People with full Medicaid and income at or below the poverty level pay $1.60 and $4.90, and residents of nursing homes pay nothing. To qualify on your own, your 2026 income must be under $23,940 as a single person or $32,460 as a couple, and your countable resources under $18,090 or $36,100.

You are enrolled automatically if you have full Medicaid, a Medicare Savings Program, or SSI. Otherwise you apply through Social Security, online or by phone, at no cost.

The program works with both stand-alone Part D plans and Medicare Advantage plans that include drug coverage.

KFF’s June 2026 analysis counted 13.6 million people with the subsidy, up from 13.1 million a year earlier, 68% of them in Advantage drug plans. It runs in all 50 states and DC but not in Puerto Rico or the other territories.

Since January 1, 2024, there is no partial version. The Inflation Reduction Act moved everyone under 150% of the poverty level who meets the resource test into the full subsidy, so the copay ceilings above apply to every applicant who qualifies.

If you were turned down years ago under the old partial rules, it is worth applying again.

What is the income limit for Medicare Extra Help in 2026?

The Extra Help income limits for 2026 are 150% of the federal poverty level: $23,940 a year for one person and $32,460 for a married couple living together, per Social Security’s operating rules effective February 11, 2026.

Alaska and Hawaii use higher poverty figures, so their limits are higher. The 2026 poverty guideline itself is $15,960 for one person plus $5,680 for each additional household member.

2026 Extra Help income limits by location

Where you live	Single (2026)	Married couple (2026)
48 states and DC	$23,940	$32,460
Alaska	$29,925	$40,575
Hawaii	$27,540	$37,335

Two rules soften the line. Social Security ignores the first $20 of monthly income, $240 a year, before comparing you to the limit. And Medicare’s own fact sheet says you may still qualify with higher income if you or your spouse support other relatives who live with you, because the household size rises with them.

Example: a single person with $1,950 a month in Social Security has $23,400 a year, under the $23,940 limit. At $2,000 a month, or $24,000 a year, the $20 monthly exclusion brings countable income to $23,760, still under the limit. Small overages are worth checking, not assuming.

Our poverty-level calculator shows where your household falls against 150% of the guideline. The next section lists exactly what Social Security counts and ignores.

The 2026 resource limit

Resources are counted separately from income. The CMS memo of October 31, 2025 sets the 2026 limits at $16,590 for a single person and $33,100 for a couple, and adds $1,500 per person if you told Social Security you plan to use some savings for burial expenses.

That produces the $18,090 and $36,100 figures Medicare.gov publishes.

Countable resources are cash, checking and savings accounts, retirement accounts, stocks, bonds, mutual funds, and real estate other than your home.

Your home, one car, household goods, personal items, a burial plot, and up to $1,500 set aside for burial do not count. The limit rises each year with inflation; the 2026 increase was 3.01%.

Income and resources that count for Extra Help

Social Security counts gross income: retirement and disability benefits, pensions, annuities, wages, self-employment earnings, alimony, and rental income. Interest and dividends are excluded. It then subtracts the $20 general exclusion and, for workers, some earned-income disregards.

Money that does not count includes SNAP, housing and energy assistance, victim compensation, disaster aid, and help from others paid straight to a landlord or utility.

On the resource side, the application asks for bank balances, retirement account values, investments, and any real estate beyond your home. Life insurance is not asked about. If you expect to use savings for burial, say so, because that is what raises your limit from $16,590 to $18,090 as a single person.

The application asks for your current income and resources. Social Security may verify them against IRS and bank records, and it reviews them again each year. Keep the statements you used in case a reviewer asks.

How much does Extra Help pay in 2026?

It pays three things: your Part D premium up to the regional benchmark, your deductible, and everything above a small copay on each prescription.

Under the CMS 2026 rules, a full-subsidy enrollee owes at most $5.10 for a generic or preferred multi-source drug and $12.65 for any other covered drug. Those caps apply at every pharmacy in your plan’s network.

2026 Medicare Part D costs with and without Extra Help

Cost in 2026	Standard Part D plan	With Extra Help
Monthly premium	Varies by plan; the base beneficiary premium is $38.99	$0 up to your region’s benchmark; you pay only any amount above it
Annual deductible	Up to $615	$0
Generic drug copay	Plan copay or 25% coinsurance (42 CFR 423.104)	Up to $5.10 (up to $1.60 with full Medicaid at or below 100% of poverty; $0 in a nursing home)
Brand-name drug copay	Plan copay or 25% coinsurance	Up to $12.65 (up to $4.90 with full Medicaid at or below 100% of poverty; $0 in a nursing home)
Yearly out-of-pocket cap	$2,100, then $0	$2,100, then $0
Part D late enrollment penalty	Added to premium for life	Waived while you have Extra Help

The copay caps have moved a little each year. They were $4.90 and $12.15 in 2025, are $5.10 and $12.65 in 2026, and CMS has already set them at $5.80 and $14.40 for 2027 in its April 6, 2026 rate announcement. The chart below tracks the three years for the standard full-subsidy tier.

The premium piece deserves one caution. Extra Help pays up to your region’s benchmark premium, a weighted average of basic plan premiums there.

If you pick a plan that costs more than the benchmark, you pay the difference. A tan LIS Choosers notice goes out in early November to people whose plan will cost more than the subsidy covers next year.

Above the $2,100 out-of-pocket cap, everyone in Part D pays nothing for covered drugs for the rest of the year, with or without the subsidy. The Medicare Part D costs guide walks through the cap, the deductible, and the 2027 changes for people who do not qualify.

What are the three things that automatically qualify you for Extra Help?

Full Medicaid, a Medicare Savings Program, or SSI. If one applies, Medicare enrolls you without an application and mails a purple Deemed Status Notice. You do not need to reply. Medicare then either keeps you in your current drug plan or, if you have none, places you in one and mails a yellow or green notice with the start date.

• Full Medicaid coverage. Your state Medicaid agency reports your status to Medicare. See the Medicaid program guide for how eligibility works after 65.
• A Medicare Savings Program. QMB, SLMB, or QI, which pay your Part B premium. QDWI pays only the Part A premium and does not qualify you. The Medicare Savings Programs guide lists the 2026 limits.
• Supplemental Security Income. Any SSI payment from Social Security qualifies you. Our SSI program page covers the 2026 payment rules.

Deemed status lasts through the end of the calendar year. Each September, Medicare mails a gray Loss of Deemed Status notice to people who no longer have Medicaid, an MSP, or SSI on record. If you get one, you can still keep the subsidy by applying to Social Security directly, and you should do so before December.

The income and resource tests for the Medicare Savings Programs sit close to the Extra Help tests, so many people qualify for both. Applying for Extra Help triggers an MSP check unless you opt out, which is the fastest way to get both benefits from one form.

How do you apply for Medicare Extra Help in 2026?

Apply through Social Security, not Medicare or your drug plan. There is no fee, no agent, and no deadline; you can apply any day of the year. Married couples living together file one application. There are three routes, and all reach the same form, SSA-1020.

1. Online. Go to SSA.gov/extrahelp and start the Medicare Extra Help application (form SSA-1020). Have your bank, retirement, and pension statements and your latest benefit letters nearby. You can save and return to it.
2. By phone. The Extra Help phone number is Social Security’s main line, 1-800-772-1213 (TTY 1-800-325-0778). A representative can take the application or mail you a paper copy.
3. With free help. Your State Health Insurance Assistance Program (SHIP) counsels for free and can file with you. Find yours at shiphelp.org or 1-877-839-2675.

Do not opt out of the Medicare Savings Program referral. Unless you tell Social Security not to, it forwards your details to your state Medicaid agency, which starts an MSP application on its own. That one choice can add Part B premium relief on top of the drug subsidy.

Social Security sends a written decision. If it says yes, the subsidy generally applies from the month you applied, and Medicare’s LI NET program at 1-800-783-1307 may reimburse drug costs you paid before a plan took effect. If it says no, you have 60 days to appeal, described below.

What happens after you are approved?

Four things change. Your copays drop to the capped amounts as soon as the subsidy posts to your plan. Any Part D late enrollment penalty stops while you have the subsidy.

You can change drug plans once a calendar month, effective the first of the next month. And your status is protected through December 31, even if your income rises mid-year.

The monthly switching right replaced the old once-per-quarter rule in 2025 under the CMS contract year 2025 final rule. It does not apply to people a plan has flagged under a drug management program. Outside of that, you no longer need to wait for fall Medicare Open Enrollment to fix a bad plan match.

Each year Social Security reviews whether you still qualify. If your income and resources are still under the limits, nothing changes.

Some people get a review form in early September, due back within 30 days, with a decision letter in November. If you no longer qualify, the subsidy ends December 31. The autumn mail sequence below shows every notice and when to expect it.

Two blue notices matter most for people Medicare placed in a plan. A late-October Reassignment Notice says your plan’s premium will exceed the benchmark and Medicare will move you to a new plan on January 1 unless you choose one. The December notice lists which of your drugs the new plan covers.

What changes for Extra Help in 2027?

CMS set the 2027 Part D parameters on April 6, 2026. The standard deductible rises from $615 to $700, and the out-of-pocket cap from $2,100 to $2,400, because the indexing increase is 13.65%.

Extra Help copays rise to $5.80 generic and $14.40 brand-name, or $1.65 and $5.00 for full Medicaid enrollees at or below the poverty level.

Premiums are the other 2027 story. The base beneficiary premium rises to $41.33, and CMS is ending the premium stabilization demonstration that held stand-alone plan premiums down in 2025 and 2026 at a cost GAO put at $9.8 billion.

Extra Help still covers premiums up to the benchmark, so the subsidy matters more next year, not less.

Two numbers are not out yet. The 2027 resource limits arrive in a CMS memo after the September inflation figures, usually late October or November. The 2027 income limits follow the January 2027 poverty guidelines. This page will be updated when both publish; until then, use the 2026 limits above.

Is Medicare Extra Help for real?

Yes. Extra Help is the plain-English name Medicare uses for the Part D Low-Income Subsidy, created by the 2003 law that built Part D and administered by Social Security and CMS. Applying is free. Nobody legitimate will charge a fee, ask for a gift card, or need your bank password to enroll you.

The scam versions borrow the name. TV and phone ads offering a “flex card” or a grocery card worth several hundred dollars are marketing for private Advantage plans or outright fraud, and none of them is Extra Help.

The real program only lowers drug costs, only through Social Security or your state, and only after you apply or are deemed eligible.

If you are unsure whether a letter is genuine, match its color and title to the list in Medicare’s fact sheet, or call 1-800-MEDICARE. Genuine Extra Help mail comes from Medicare, Social Security, or your Part D plan, never from an insurance broker.

Extra Help vs Medicare Savings Programs vs Medicaid

These three programs stack, and the confusion between them keeps people from claiming all of them. Extra Help covers drug costs only.

The Medicare Savings Programs cover Part B premiums and, at the QMB level, Part A and B cost sharing. Full Medicaid covers what Medicare does not, including long-term care, and brings Extra Help with it automatically.

PACE and Dual Eligible Special Needs Plans round out the picture for people who also need long-term care or a single coordinated plan. The Medicare help for low-income seniors guide lays all five out side by side with the 2026 limits.

Extra Help vs Medicare Savings Programs vs Medicaid, 2026

Program	What it pays	2026 income test (single, 48 states)	Who runs it
Extra Help (Part D LIS)	Part D premium to benchmark, deductible, most copays	Under $23,940 (150% of poverty)	Social Security and CMS
Medicare Savings Programs (QMB, SLMB, QI)	Part B premium; QMB also pays Part A and B deductibles and coinsurance	Roughly 100% to 135% of poverty, varies by state	State Medicaid agency
Full Medicaid	Most costs Medicare leaves, plus long-term care	Set by each state	State Medicaid agency

The combination most low-income beneficiaries should aim for is an MSP plus Extra Help: the state pays the $202.90 monthly Part B premium and the subsidy pays the drug plan.

Because the applications share data, filing for one usually starts the other. The Medicaid income limits guide covers the state-by-state rules for full coverage.

Can you appeal an Extra Help denial?

Yes, within 60 days of receiving the decision. Social Security assumes you received the letter five days after its date.

Ask for a hearing by phone or a review of your file using form SSA-1021, available at SSA.gov or by phone. A different reviewer looks at the case, and you can send corrected income or resource figures with the request.

Before you appeal, check whether Social Security counted a resource that should not have counted, or income reported gross when part of it was excludable. Review the resource rules above, then appeal with the corrected numbers. If you miss the 60 days, you can simply file a new application; there is no waiting period.

The bottom line on Extra Help in 2026

Extra Help removes the Part D premium up to your benchmark, the $615 deductible, and all but $5.10 or $12.65 per prescription for anyone under $23,940 in income ($32,460 for a couple) with resources under $18,090 ($36,100).

Medicaid, an MSP, or SSI enrolls you automatically. Everyone else should apply at SSA.gov or by phone and keep the Medicare Savings Program referral turned on.

Apply now rather than in December. Approval covers the month you apply, the subsidy runs through the end of the year regardless of income changes, and 2027’s higher deductible and copays raise the value of the subsidy.

For the broader picture of senior benefits, see our guide for people 65 and older and the Medicare program overview.