Find out if you qualify for Extra Help to pay for the costs of your prescription drugs through Medicare’s Part D Low Income Subsidy.
What is the Medicare Part D plan, what is the amount that beneficiaries receive, and how do I enroll to receive Extra Help?
Learn more about what Part D Extra Help covers, including what you might pay for your prescriptions at the pharmacy.
Beneficiaries with Medicare who have limited income and assets may qualify for Extra Help with the costs of their prescription drugs. This program is also known as LIS, or the Part D Low Income Subsidy. The Social Security Administration (SSA) and the Centers for Medicare & Medicaid Services (CMS) work together to provide the benefit.
Who qualifies for Extra Help?
Some people get Part D Extra Help automatically. These include people who are enrolled in both Medicaid and Medicare (often called dual eligible), those receiving Supplemental Security Income (SSI), and those who qualify for a Medicare Savings Program. If you receive benefits from these programs, you do not need to apply for Extra Help, though they may still wish to consult a benefits counselor to determine the best Part D plan to suit your situation.
Anyone else who is not already enrolled in the benefits noted above must apply to Social Security to receive Extra Help. The income and asset requirements are available in this chart.
Benefits of Extra Help
The amount of Extra Help you receive depends on your income and resources. You will receive either a full-subsidy or a partial-subsidy. Most people who qualify for Extra Help will pay:
- No premiums,
- No deductibles (unless receiving the partial subsidy), and
- No more than $9.20 in 2021 for each drug their plan covers.
In addition to lower out-of-pocket costs, beneficiaries with Extra Help have the following protections:
- A quarterly Special Enrollment Period (one time every three months between January - September + once during Annual Open Enrollment) to join or switch Medicare Part D drug plans during the year. These opportunities allow people who get Extra Help to not wait for the Annual Open Enrollment Period (Oct. 15 – Dec. 7) to change plans. Any plan changes made outside the Annual Open Enrollment Period will become valid for the following month. This is especially helpful to seniors/adults with disabilities who may need to begin medications that are not on their current plan’s formulary (approved drug list).
- No Part D late enrollment penalty, even if you enroll late (that is, after you were first eligible to join a Part D plan and did not have other drug coverage).
Ways to Apply for Medicare Part D Extra Help
If you think you or someone you know may be eligible for Extra Help, visit the following:
- BenefitsCheckUp® has a direct link to submit Extra Help applications to the SSA. In addition, NCOA's free online screening tool will tell applicants if they likely appear eligible for other benefits that can help with health care and prescription costs.
- Their local State Health Insurance Assistance Program (SHIP). SHIPs are federally funded to provide free, objective assistance to people with Medicare and their families. SHIPs also can help with applications for Extra Help and the Medicare Savings Programs. To find your SHIP, call toll-free 877-839-2675 or visit the SHIP TA Center website.
- People with Medicare can also apply directly through the Social Security Administration.