Medicare drug cost help
Last checked: May 2026
If your parent, spouse, or other loved one has Medicare and high drug costs, Extra Help may lower what they pay for Medicare Part D.
This guide explains what Extra Help is, who may qualify, where to apply, what papers to gather, and what to do if the first answer is no.
Quick answer
Extra Help is a Medicare program for people with limited income and resources. It helps pay Medicare Part D drug plan costs. It may lower the plan premium, deductible, and drug copays.
Some people get it automatically. Others must apply through Social Security. A caregiver can help gather papers, fill out the application, call Social Security, and ask SHIP to review drug plan choices.
Start with the official Social Security Extra Help application page. Social Security says you can apply before or after the person enrolls in Part D.
Also check the official Medicare page on help with drug costs. Medicare lists the current income and resource limits, automatic eligibility rules, and what a person may pay under Extra Help.
Who this helps
This page is for you if you are helping someone who has Medicare and struggles to pay for medicine.
It may help if your loved one:
- has a Medicare Part D drug plan,
- has a Medicare Advantage plan that includes drug coverage,
- has not joined a drug plan yet,
- gets Medicaid, SSI, or help from a Medicare Savings Program,
- has been told a medicine is covered but still costs too much, or
- missed Part D before and is worried about a late enrollment penalty.
If you are still learning what Medicare does and does not pay for, start with our guide to what Medicare covers. Extra Help is not the same as full Medicaid, long-term care help, or home care help.
What Extra Help may lower
Extra Help is also called the Part D Low-Income Subsidy, or LIS. It is tied to Medicare drug coverage.
Medicare says Extra Help can help pay Medicare drug coverage costs, including premiums, deductibles, coinsurance, and other Part D costs. It also says a person does not pay a Part D late enrollment penalty while getting Extra Help.
| Cost problem | How Extra Help may help | What to check |
|---|---|---|
| Monthly Part D premium | May reduce the premium, often to $0 for a qualifying basic plan. | Ask SHIP or Medicare to check whether the current plan has any extra premium. |
| Drug deductible | Medicare lists a $0 plan deductible for people with Extra Help in 2026. | Check that the pharmacy is billing the Medicare drug plan correctly. |
| Copays for covered drugs | In 2026, Medicare lists copays up to $5.10 for each generic drug and up to $12.65 for each brand-name drug. | Make sure the drug is covered by the plan and the pharmacy is in the plan network. |
| High yearly drug costs | Medicare says once total drug costs reach $2,100 in 2026, the person pays $0 for each covered drug. | Keep receipts and plan letters if costs seem wrong. |
| Part D late enrollment penalty | Medicare says the person will not pay the Part D late enrollment penalty while getting Extra Help. | Call 1-800-MEDICARE if the penalty still appears on the bill. |
Important: Extra Help lowers Medicare drug costs. It does not make every drug free. It does not force every plan to cover every medicine. The person may still need a plan review, a formulary exception, or a different covered drug.
Who may qualify in 2026
Medicare says people usually must have income and resources below certain limits to qualify for Extra Help. These limits can change each year.
For 2026, Medicare lists these limits for most people:
- Individual: income below $23,940 and resources below $18,090.
- Married couple: income below $32,460 and resources below $36,100.
Income and resource rules can be tricky. Not every dollar or item counts the same way. Social Security asks for financial information when the person applies. Do not assume the person is over the limit without checking.
The limits may be different for Alaska and Hawaii. Extra Help is not available in Puerto Rico, the U.S. Virgin Islands, Guam, the Northern Mariana Islands, or American Samoa, but Medicare says those areas may have other programs. Call the local Medicaid office if the person lives in a U.S. territory.
If your loved one also needs help with Medicare premiums or other Medicare costs, ask the state Medicaid office about Medicare Savings Programs. If income is part of the problem, our Medicaid spend-down guide may help you understand another benefit path.
Some people get Extra Help automatically
Medicare says a person gets Extra Help automatically if they get any of these:
- Full Medicaid coverage,
- help from the state paying Medicare Part B premiums through a Medicare Savings Program, or
- Supplemental Security Income, also called SSI.
If this applies, the person should get a notice in the mail. The notice should explain their Extra Help and drug plan information.
If the person has Medicaid or a Medicare Savings Program but the drug plan still charges too much, do not ignore it. Call the plan, Medicare, or SHIP. Medicare says the plan may ask for proof that the person gets Extra Help so it can correct the cost.
Where to start first
Use the path that matches the person’s current situation.
| Situation | First place to start | Why |
|---|---|---|
| The person does not have Medicaid, SSI, or a Medicare Savings Program. | Apply through Social Security. | Social Security handles Extra Help applications. |
| The person may also need help with Medicare Part B premiums. | Apply for Extra Help and ask about a Medicare Savings Program through the state Medicaid office. | Medicare says Social Security can send Extra Help application information to the state to start an MSP application unless the person says not to. |
| The person already has Medicaid, SSI, or an MSP. | Check the mail for the Extra Help notice. If costs look wrong, call the drug plan or 1-800-MEDICARE. | The person may already qualify automatically. |
| The person is confused by plan choices. | Contact the local SHIP through SHIPHelp.org or call 1-877-839-2675. | SHIP gives free one-on-one Medicare counseling and can help with Extra Help and plan checks. |
Do this first today
- Make a list of the person’s current medicines, doses, and pharmacy.
- Check whether they already get Medicaid, SSI, or help paying the Part B premium.
- Gather bank statements and income papers.
- Apply through Social Security or call Social Security for an appointment.
- Ask SHIP to check the drug plan before or during Open Enrollment.
Your state still matters
Extra Help is a federal Medicare program. But your state still matters because Medicaid and Medicare Savings Programs run through state Medicaid offices.
If your loved one may qualify for Medicaid or help paying Medicare premiums, contact the state Medicaid office. The name of the program may be different in each state.
SHIP also has different names by state. Some states call it HICAP, SHIIP, SHINE, VICAP, or another name. Use the official SHIP locator to find the right local office.
State rules can affect Medicaid, Medicare Savings Programs, and other drug help. They can also affect what proof is needed and where forms are sent. Treat this national guide as a starting point, not as a final state decision.
What documents may be needed
Social Security lists these papers to help prepare for an Extra Help application:
Document checklist
- Bank statements.
- Tax returns, if available.
- IRA account balances.
- 401(k) account balances.
- Pension statements.
- Veterans benefit statements.
- Annuity statements.
- Railroad Retirement Board benefit statements, if any.
- Medicare card.
- Medicaid card, SSI notice, or Medicare Savings Program notice, if the person has one.
- Current Medicare drug plan card.
- List of medicines and the pharmacy used most often.
If you are the caregiver, you may also need permission to speak for the person. A power of attorney, authorized representative form, or the person being on the phone with you may help. For more on legal papers, read power of attorney for an aging parent.
What to do at Medicare Open Enrollment
Medicare Open Enrollment runs from October 15 through December 7 each year. Changes start January 1 if the plan gets the enrollment request by December 7.
During Open Enrollment, a person in Original Medicare can join, drop, or switch a Medicare drug plan. A person may also review Medicare Advantage plans with drug coverage.
Extra Help can lower costs, but the drug plan still matters. Each plan has its own covered drug list, pharmacy network, and rules. A plan that worked last year may not be the best plan next year.
Open Enrollment drug plan check
- Make a fresh medicine list before October 15.
- Add the exact dose and how often the person takes each drug.
- List the current pharmacy and any mail-order option.
- Use Medicare Plan Compare or ask SHIP to compare plans.
- Ask whether the person’s Extra Help level is showing correctly.
- Check the total yearly cost, not just the monthly premium.
- Save plan letters and confirmation numbers.
Medicare says that starting in 2025, if a person has Medicaid or gets Extra Help, they may be able to change drug coverage once per month. Ask Medicare or SHIP before switching. A fast switch can help in some cases, but it can also cause new pharmacy or drug list problems.
What usually goes wrong
Common problems caregivers run into
- Assuming the person is over the limit. Some income and resources may be treated differently. Apply or ask SHIP before giving up.
- Missing automatic eligibility. If the person has Medicaid, SSI, or a Medicare Savings Program, they may already qualify.
- The pharmacy charges too much. The plan may not have the Extra Help record yet, or the pharmacy may not be billing the right plan.
- The drug is not covered. Extra Help lowers Part D costs, but the drug must still be covered by the plan unless an exception is approved.
- The plan premium is still not $0. The person may be in a plan that costs more than the amount Extra Help covers in that area.
- Mail gets missed. Medicare and Social Security notices can explain plan changes, proof needed, or appeal rights.
- No one checks the plan in fall. Drug plans can change each year. Open Enrollment is the time to compare.
If the problem is a denied drug, not an Extra Help denial, you may need a Part D coverage request or appeal. Our guide to appealing a Medicare denial explains the basic steps.
What to do if the first path does not work
A first no does not always end the matter. The next step depends on why the first path failed.
If Social Security says the person does not qualify
Read the notice. Check the income and resource numbers used. If something is wrong, ask Social Security how to appeal. Social Security has an SSA-1021 appeal form for Extra Help decisions.
If income or resources changed
Medicare says a person can reapply for Extra Help any time if income or resources change. This can matter after a spouse dies, work stops, savings drop, or medical costs rise.
If the person needs more than drug help
Apply for a Medicare Savings Program or Medicaid through the state. These may help with other Medicare costs. Rules and names vary by state.
If the drug still costs too much
Call the drug plan and ask whether Extra Help is on file. Then ask whether the drug is covered, needs prior approval, has a quantity limit, or has a lower-cost covered option.
If the person is leaving a hospital or nursing facility and needs medicine right away, ask the discharge planner for help before discharge. Our hospital discharge rights guide explains what to ask before the person goes home.
Call scripts caregivers can use
Call Social Security to apply or ask for an appointment
“Hello, I am helping my [mother/father/spouse] apply for Extra Help with Medicare Part D drug costs. I want to set up an appointment or ask what information is needed. They have Medicare. Can you tell me the next step and whether they need to be on the phone with me?”
Call the drug plan if the pharmacy price looks wrong
“Hello, I am helping with this member’s prescription costs. They qualify for Extra Help, but the pharmacy charged more than expected. Can you check whether Extra Help is active on the plan and whether this drug was billed correctly?”
Call SHIP for free plan help
“Hello, I need help checking Medicare Part D drug costs for someone who may qualify for Extra Help. Can a counselor help compare plans and check whether Extra Help or a Medicare Savings Program may apply?”
You can find more caregiver-friendly wording on our phone scripts page.
What a caregiver can do without taking over
You can help a lot, even if you are not the person’s legal agent.
- Gather medicine bottles and make a list.
- Find Medicare, Medicaid, SSI, and plan cards.
- Help the person open and sort mail from Medicare, Social Security, Medicaid, and the drug plan.
- Sit with the person during a Social Security or SHIP call.
- Ask the person to give verbal permission during the call if the agency needs it.
- Write down names, dates, phone numbers, and confirmation numbers.
- Keep proof of payments and pharmacy receipts if costs may need to be corrected.
If the person wants you to handle calls often, ask the agency or plan what form is needed. For some tasks, a power of attorney may not be enough by itself. Each agency and plan may have its own permission process.
Official sources used and what we checked for this update
For this May 2026 update, we checked these official sources first:
- Medicare.gov: Help with drug costs for what Extra Help is, 2026 income and resource limits, automatic eligibility, 2026 cost amounts, and what to do if the person is paying the wrong amount.
- Social Security: Apply for Medicare Part D Extra Help for where to apply, what documents can help, and the Social Security phone number.
- Medicare.gov: Open Enrollment for the October 15 through December 7 Open Enrollment dates and plan change rules.
- ACL: State Health Insurance Assistance Program for SHIP’s role in helping people with Medicare, Medicaid, Medicare Savings Programs, and Extra Help.
- SHIPHelp.org for the official SHIP locator and the 1-877-839-2675 SHIP phone number.
- Medicaid.gov: Seniors and Medicare and Medicaid enrollees for how Medicaid can help some Medicare enrollees with premiums and out-of-pocket costs.
- SSA Form SSA-1021 for appealing an Extra Help decision.
We also checked that Medicare says limits may rise each year. Always confirm current limits on Medicare.gov or with Social Security before applying.
Resumen en español
Extra Help es un programa de Medicare que puede bajar los costos de medicinas de la Parte D. Puede ayudar con la prima, el deducible y los copagos.
Algunas personas reciben Extra Help automáticamente si tienen Medicaid completo, SSI, o ayuda del estado para pagar la prima de Medicare Parte B. Otras personas deben solicitarlo con el Seguro Social.
Antes de llamar, junte estados de cuenta bancarios, información de ingresos, tarjetas de Medicare y Medicaid, y una lista de medicinas. También puede llamar a SHIP para ayuda gratis con Medicare.
About this guide
CaregiverBenefits.org writes guides for family caregivers who need real benefit steps. This page focuses on Extra Help for Medicare Part D drug costs. It is not a general Medicare plan shopping page.
We checked official Medicare, Social Security, Medicaid, ACL, and SHIP sources for this update. We link to official sources near the claims they support so you can verify the rules.
Plain disclaimer
This guide is for general information. It is not legal, tax, or benefits advice. Medicare, Social Security, Medicaid, and plan rules can change. Always confirm details with Medicare, Social Security, your state Medicaid office, SHIP, or the drug plan before acting.
FAQ
What is Extra Help for Medicare Part D?
Extra Help is a Medicare program for people with limited income and resources. It helps lower Medicare Part D drug plan costs, including premiums, deductibles, and copays.
Can a caregiver apply for Extra Help for someone else?
A caregiver can help gather papers, fill out forms, and call with the person. Social Security or the drug plan may need the person’s permission before talking about private information.
Who gets Extra Help automatically?
Medicare says people get Extra Help automatically if they have full Medicaid, get help from a Medicare Savings Program paying Part B premiums, or get SSI payments from Social Security.
Where do you apply for Extra Help?
Apply through Social Security online or by phone. You can also ask SHIP for free help with the application and drug plan review.
Does Extra Help pay for all medicines?
No. Extra Help lowers Part D costs, but the drug usually still needs to be covered by the person’s drug plan. If a drug is denied, ask the plan about a coverage request or appeal.
Can someone apply if they were denied before?
Yes. Medicare says a person can reapply any time if income or resources change. If the denial seems wrong, ask Social Security how to appeal the decision.
Should Extra Help recipients still check plans during Open Enrollment?
Yes. Extra Help lowers costs, but plans can change drug lists, pharmacy networks, and plan rules. Open Enrollment is a good time to compare the current plan with other choices.
