What Is Medicare Extra Help?

Medicare Extra Help provides about $5,300 in annual benefits for Medicare Part D premiums, copays and deductibles.
Alex Rosenberg
By Alex Rosenberg 
Updated
Edited by Holly Carey

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Nerdy takeaways
  • Extra Help pays for some or all of your premiums and out-of-pocket costs for Medicare Part D (prescription drugs).

  • Full Medicaid coverage, SSI and certain Medicare Savings Programs automatically qualify you for Extra Help.

  • If you don't qualify automatically, you can apply and show that your income and resources are below the caps.

  • You apply for Extra Help through the Social Security Administration.

MORE LIKE THISMedicareInsurance
Nerdy takeaways
  • Extra Help pays for some or all of your premiums and out-of-pocket costs for Medicare Part D (prescription drugs).

  • Full Medicaid coverage, SSI and certain Medicare Savings Programs automatically qualify you for Extra Help.

  • If you don't qualify automatically, you can apply and show that your income and resources are below the caps.

  • You apply for Extra Help through the Social Security Administration.

MORE LIKE THISMedicareInsurance

Extra Help is a federal program that helps Medicare beneficiaries with low income and limited resources pay for prescription drugs with Medicare Part D.

The government estimates that Extra Help — also known as the Part D Low-Income Subsidy — is worth about $5,300 per year for qualifying Medicare Part D beneficiaries.

Here’s what you need to know about the benefits, requirements and application process for Extra Help.

Still deciding on the right carrier? Compare Medicare Part D Plans

Medicare Extra Help eligibility

You can qualify for Extra Help if you are entitled to Medicare Part A and/or Part B, live in any of the 50 states or Washington, D.C., are not incarcerated and have both limited resources and limited income.

There are two ways to get Extra Help:

  • Automatically. If you get assistance from certain government programs, you qualify for Extra Help automatically. You don’t need to apply.

  • By applying. If you don’t get Extra Help automatically, you can apply and qualify if your income and resources are below certain limits.

Who automatically receives Extra Help?

You're automatically eligible for Extra Help if you have Medicare Part A and/or Part B and at least one of the following applies:

  • You're entitled to Supplemental Security Income, or SSI.

  • You're eligible for full Medicaid coverage.

  • You're enrolled in a Medicare Savings Program as a Qualified Medicare Beneficiary, Specified Low-Income Medicare Beneficiary or Qualified Individual.

If you automatically qualify, you don’t need to apply to receive the benefits.

If you don’t automatically qualify, you should still apply for Extra Help if you might meet the income and resource criteria.

Extra Help income limits

Income limits for Extra Help are based on the federal poverty level, or FPL. The 2023 income limits for those in the contiguous states and the District of Columbia (the numbers are different for those in Alaska and Hawaii) are:

Limit for partial subsidies

Limit for full subsidies

Percentage of the FPL

150%.

135%.

Individuals

$1,823 per month, or $21,870 per year.

$1,640 per month, or $19,683 per year.

Married couples

$2,465 per month, or $29,580 per year.

$2,219 per month, or $26,622 per year.

The latest income thresholds for all states and household sizes can be found on the Department of Health and Human Services’ HHS Poverty Guidelines for 2023.

There are many exceptions to what counts as income. For example, food, housing and home energy assistance from the government, scholarships, grants and even payments you get from others to help with your household expenses don’t count toward Extra Help’s income limits.

🤓Nerdy Tip

2023 is the last year for partial subsidies. Starting in 2024, the full Extra Help subsidy will be available for people earning up to 150% of the FPL.

Extra Help resource limits

“Resources” include your bank accounts, cash at home, investments like stocks and bonds, and real estate other than your primary residence.

For 2023, the Extra Help resource limits are:

Limit for partial subsidies

Limit for full subsidies

Individuals

$16,660.

$10,590.

Married couples

$33,240.

$16,630.

The limits listed above include an additional allowance for beneficiaries who plan to use some resources for burial expenses. That allowance increases the limits by $1,500 for individuals or $3,000 for married couples.

Not everything you own counts as a “resource.” For example, your home, personal possessions, vehicles, insurance policies, back payments from Social Security or SSI, and burial plots or contracts don’t count toward the resource limits.

Extra Help benefits

Extra Help applies to your choice of Medicare Part D plan or Medicare Advantage plan with prescription drug coverage. For qualifying beneficiaries, Extra Help provides:

  • Part D premium subsidies up to 100% of the cost of benchmark Part D premiums in your area. (You will need to pay the difference if you choose a more expensive Part D plan.)

  • Reduced or eliminated Part D deductibles.

  • Caps on prescription drug copays as low as $1.45 for generics and $4.30 for brand-name medications.

In some cases, if you don’t qualify for the full benefits, you can still receive partial benefits on a sliding scale according to your income and resources.

How do I apply for Extra Help?

You apply for Extra Help through the Social Security Administration:

You will need to provide information about your household, work, resources and monthly income as part of the application.

Frequently asked questions

To get a partial Extra Help subsidy, the 2023 income limit is $1,823 per month for individuals or $2,465 per month for couples. For the full subsidy, the limits are $1,640 per month for individuals or $2,219 per month for couples.

Yes. There are many exceptions to what counts as income and resources. It’s possible you could meet the requirements once those exceptions are factored in.

Even if you don’t meet the requirements, you can apply for Extra Help and other assistance programs at the same time using the same information, so you might be able to get help from another program.

No. You’ll be automatically enrolled in a Medicare Part D prescription drug plan if you qualify for Extra Help and you’re not already enrolled. If you want another plan instead, you can switch.

Still deciding on the right carrier? Compare Medicare Part D Plans

Still deciding on the right carrier? Compare Medicare Part D Plans

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