What Extra Help does
Medicare.gov describes Extra Help as a Medicare program that helps people with limited income and resources pay Medicare Part D premiums, deductibles, coinsurance, copays, and other drug costs. It is not a separate drug plan. It is help that works with Medicare drug coverage.
Who gets Extra Help automatically
Medicare.gov says people get Extra Help automatically if they have full-benefit Medicaid, get help from the state paying Part B premiums through a Medicare Savings Program, or receive Supplemental Security Income payments from Social Security. If Extra Help is automatic, Medicare sends a notice explaining the help and what the person will pay.
Who should apply
People who do not get Extra Help automatically can apply if their income and resources are below the current limits. Medicare.gov lists 2026 limits of $23,475 income and $18,090 resources for an individual, and $31,725 income and $36,100 resources for a married couple. These limits can change, and some income or resources may be counted differently, so a close case is worth checking.
How to apply
Social Security says you can apply for Extra Help any time before or after enrolling in Part D. The application asks for financial information. Helpful documents can include bank statements, tax returns, retirement-account balances, pension statements, Veterans benefits, annuities, and Railroad Retirement Board benefit information.
What Extra Help pays in 2026
For 2026, Medicare.gov lists a $0 plan premium, $0 plan deductible, up to $5.10 for each covered generic drug, and up to $12.65 for each covered brand-name drug. Once out-of-pocket drug costs, including certain payments made on the person's behalf, reach $2,100, the person pays $0 for each covered drug for the rest of the year.
Why plan review still matters
Extra Help lowers costs, but it does not make every plan equally good. Formularies, pharmacy networks, prior authorization, step therapy, quantity limits, and mail-order options can still affect access. The best review starts with the actual medication list, dosage, refill pattern, and preferred pharmacies.
Automatic enrollment if there is no drug plan
Medicare.gov says people who qualify for Extra Help may be automatically enrolled in a Medicare drug plan if they do not already have one. The notice explains the new plan and gives the person the option to choose a different Medicare drug plan. That notice should be read before assuming the assigned plan is the best fit.
How long Extra Help lasts
Medicare.gov says that once someone qualifies, they keep Extra Help through December 31 of that year, even if income changes during the year. If they still meet the limits for the next year, they keep Extra Help. Medicare or Social Security generally sends a notice if the person no longer qualifies or if the plan changes for the next year.
Extra Help and late-enrollment penalties
Medicare.gov says people do not have to pay a Part D late-enrollment penalty while they get Extra Help. That can be a major relief for someone who delayed drug coverage or had a coverage gap. If Extra Help ends later, the person should review coverage promptly so a new gap does not create trouble.
LI NET can fill a temporary gap
Medicare's Limited Income Newly Eligible Transition program, often called LI NET, can provide temporary Part D coverage for people who qualify for Extra Help or Medicaid but are not yet enrolled in a Medicare drug plan. Medicare.gov says LI NET covers all Part D covered drugs and does not use network pharmacy restrictions.
What to do if the pharmacy price looks wrong
If someone with Extra Help is charged more than expected, Medicare.gov recommends contacting the drug plan and telling the plan how many days of medication are left. The plan may ask for proof of Extra Help. Medicare can also confirm the person's level of Extra Help and help get plan costs corrected.