“Extra Help” for Medicare Part D: How It Works and How It Lowers Your Drug Costs

If you have Medicare Part D (prescription drug coverage) and your income or savings are limited, the “Extra Help” program may significantly reduce what you pay for prescriptions. Many people also hear it called Medicare’s Low‑Income Subsidy (LIS).

This guide explains, in plain language, what Extra Help is, who may qualify, how it typically lowers costs, and how to move forward through official channels. HowToGetAssistance.org is an informational resource only—it is not a government office and cannot process applications or check your status.

What Is “Extra Help” for Medicare Part D?

Extra Help is a federal assistance program that helps people with limited income and resources pay for:

• Monthly Part D plan premiums
• Annual deductibles
• Copayments or coinsurance for prescription drugs
• Coverage during the “donut hole” (the Part D coverage gap)
• Some late enrollment penalties in certain situations

The program is overseen by Medicare and the Social Security Administration (SSA), but enrollment is usually handled through official federal websites, phone lines, or local offices, not through private information sites like this one.

In many cases, people who receive Extra Help see their prescription costs drop to a low copay or even $0 for covered drugs, depending on their level of help and the type of medication.

How Extra Help Lowers Prescription Drug Costs

Exactly how much your costs go down depends on your income, resources, and the level of Extra Help you qualify for. Typically, Extra Help can reduce or eliminate:

1. Monthly Part D Premiums

With Extra Help, you may:

• Pay no premium for certain “benchmark” Part D plans in your area, or
• Pay a reduced premium if your chosen plan costs more than the benchmark amount

If you already have a Part D plan and then qualify for Extra Help, your plan cost is usually adjusted automatically once your Extra Help status is active.

2. Annual Deductible

Many Part D plans charge a deductible you must pay before the plan starts covering drugs. With Extra Help:

• Your deductible may be much lower, or
• You may have no deductible at all

3. Copays and Coinsurance at the Pharmacy

Instead of paying the plan’s standard copays or coinsurance, people with Extra Help typically pay:

• Lower fixed copays for generic and brand-name drugs, or
• A reduced coinsurance percentage of the drug cost

These reduced amounts apply as long as the drug is covered by your Part D plan’s formulary and other plan rules (such as prior authorization or step therapy) are followed.

4. Help in the Coverage Gap (“Donut Hole”) and Catastrophic Phase

Normally, people with Part D may face changing costs throughout the year:

• Start of the year (deductible phase)
• Initial coverage
• Coverage gap (“donut hole”)
• Catastrophic coverage

Extra Help smooths out these phases. Instead of a big spike in costs in the coverage gap, you generally keep paying your lower Extra Help copays or percentages until you reach catastrophic coverage, where costs may drop further.

Who Typically Qualifies for Extra Help?

Eligibility for Extra Help is based on income and resources, and on having Medicare Part A and/or Part B and a Part D plan (or eligibility to enroll in one).

Because income and asset limits can change over time, you’ll want to check the current thresholds with:

• The Social Security Administration (SSA)
• The official Medicare helpline
• A local State Health Insurance Assistance Program (SHIP) or similar counseling service

General Categories of People Who Often Qualify

People are often found eligible for Extra Help if they:

• Have Medicaid (known by different names in different states)
• Receive Supplemental Security Income (SSI)
• Get help with Medicare costs through a Medicare Savings Program (MSP)
• Have low to moderate income and limited savings/investments

Some people are automatically enrolled in Extra Help if they have both Medicare and full Medicaid or receive SSI. Others need to submit an application.

Do You Get Extra Help Automatically?

You may be enrolled in Extra Help automatically if you:

• Have Medicare and are enrolled in full Medicaid, or
• Receive SSI (and have Medicare), or
• Are in certain types of Medicare Savings Programs that help pay Part B premiums

In these situations, agencies typically share information so that you don’t need to file a separate Extra Help application. People often receive a letter by mail from Medicare or SSA informing them of their Extra Help status.

If you are not sure whether you have Extra Help, you can:

• Check your Medicare Summary Notice (MSN)
• Call the official Medicare helpline
• Contact the Social Security Administration
• Ask a local SHIP counselor or Area Agency on Aging to help you review your coverage

What If You Are Not Enrolled Automatically?

If you are not automatically enrolled, you may still qualify based on your income and resources. In that case, you usually need to apply through official channels.

You do not apply for Extra Help through HowToGetAssistance.org. Instead, people typically use:

• The Social Security Administration’s official online application
• The SSA toll-free phone line to complete an application
• A local Social Security office, Medicaid office, or benefit counselor who can help you with the process

Exact options can vary somewhat by location, so you may want to contact:

• Your local Social Security office
• Your state’s Medicaid or aging services office
• Your State Health Insurance Assistance Program (SHIP)

They can point you to the correct official portal or office for your area.

What Documents and Information to Gather

When applying or being screened for Extra Help, it is helpful to have financial and identification documents ready. Requirements may differ slightly by state or by how you apply, but people are often asked for:

Personal Identification

• Full legal name
• Social Security number
• Date of birth
• Address and contact information
• Medicare card (showing Parts A and/or B)

Income Information

You may need amounts for you (and, if applicable, your spouse):

• Monthly Social Security benefits
• Pension or retirement income
• Wages from work
• Other regular income, such as annuities, rental income, or alimony

Typical documents:

• Benefit award letters
• Recent pay stubs
• Pension statements
• Bank statements showing direct deposits

Resource (Asset) Information

Resources usually include (for you and, if applicable, your spouse):

• Checking and savings accounts
• Certificates of deposit (CDs)
• Stocks, bonds, and mutual funds
• Certain retirement accounts (IRAs, 401(k)s, etc.)

Some things usually do not count as resources, such as:

• Your primary home
• One vehicle (under most rules)
• Personal belongings and household items

Because rules can change, ask the Social Security Administration or your state’s Medicaid office how your specific resources are counted.

Insurance and Benefit Details

You may also be asked about:

• Your current Medicare Part D plan (if you have one)
• Any Medicaid coverage
• Any Medicare Savings Program enrollment
• Other insurance that may help pay for prescriptions

Having plan ID cards, Medicaid letters, and recent plan notices nearby can be very helpful.

How and Where to Apply for Extra Help

You cannot apply for Extra Help on this website. To move forward, people generally use one of these official channels:

1. Apply Online (Through the Official SSA Website)

Many people use the Social Security Administration’s official online application for Extra Help. This is typically available on SSA’s main website under Medicare-related benefits.

You can:

• Complete the application on your own
• Save and come back later (in some cases)
• Print a copy for your records

Make sure you are on a .gov site. Look for “Social Security Administration” clearly displayed and check the web address carefully before entering personal information.

2. Apply by Phone

If you prefer, you may call:

• The Social Security Administration’s national phone line
• In some cases, a local Social Security office
• Certain community agencies that help people complete Extra Help applications by phone

You can ask a representative to:

• Take your application over the phone, or
• Mail you a paper application to fill out and return

3. Apply In Person

In many communities, you may be able to get help in person from:

• A local Social Security office
• A State Health Insurance Assistance Program (SHIP) counselor
• An Area Agency on Aging
• Some community health centers or nonprofit senior services organizations

Staff at these locations cannot approve you on the spot, but they can help you fill out the correct forms and submit them to the official agencies.

What Happens After You Apply?

Although details can vary, the typical process looks like this:

1. Application is reviewed
   The Social Security Administration (and sometimes your state Medicaid agency) reviews your income, resources, and Medicare status.

2. You receive a notice by mail
   You are usually sent a letter telling you:

   • Whether you were approved or denied
   • The level of Extra Help you qualify for
   • When your Extra Help will start
   • Any steps you may need to take (such as choosing a Part D plan)

3. Plan Enrollment or Changes

   • If you are not already in a Part D plan, you may be assigned to a plan, or
   • You may be allowed to choose a plan that works better for you
     People with Extra Help often have more flexibility to switch plans during the year than people without it.

4. Pharmacy Costs Go Down
   Once your Extra Help is active and your plan is updated, your copays and other costs at the pharmacy should reflect your new level of Extra Help.

   • Keep your new plan card and any letters from Medicare or SSA
   • Show them to the pharmacist if your copay doesn’t look right

5. Periodic Reviews
   Extra Help is not always permanent. Your eligibility may be reviewed each year or when your circumstances change. You might receive forms asking you to update your income or resource information.

Common Reasons for Delays or Denials

People sometimes experience delays or denials for reasons that can often be fixed. Common issues include:

• Incomplete applications
  Missing signatures, unanswered questions, or missing pages can slow things down.

• Incorrect or outdated income information
  Not reporting all sources of income or using older numbers can cause problems.

• Resource details not matching records
  If bank balances or investments on the application don’t match what agencies see, they may ask for clarification.

• Not meeting income or asset limits
  If your income or resources are above the current program thresholds, you may be found ineligible.

• Not responding to follow-up requests
  If the agency asks for more documents and you don’t respond by their deadline, your application may be denied or closed.

If you receive a denial letter, read it carefully. It usually explains:

• Why you were denied
• When any appeal or reconsideration is due
• Which office to contact for questions

How Appeals and Reviews Usually Work

If you think the decision about your Extra Help eligibility is incorrect, you may have the right to request a review or appeal. This process is time‑sensitive.

Typical steps:

1. Read the decision letter
   The letter usually tells you:

   • How to request a reconsideration
   • The deadline for appealing
   • Whether you need to send additional documents

2. Gather supporting documents
   You may want to collect:

   • Updated bank statements
   • Income verification (award letters, pay stubs)
   • Proof of recent changes, like medical bills or job loss, if relevant and requested

3. Submit the appeal through the official channel
   Appeals can often be filed:

   • By mail (using the instructions and address in your letter)
   • By phone, in some cases
   • With help from a local Social Security office or SHIP counselor

4. Wait for a new decision
   Once the agency reviews your appeal and documents, they will mail you another letter with an updated decision.

If you’re unsure how to proceed, you can contact:

• The Social Security Administration
• Your local Area Agency on Aging
• Your state’s SHIP program
  for free counseling and guidance.

If You Don’t Qualify for Extra Help

Not everyone meets the criteria for Extra Help, but there are often other ways to reduce prescription costs. Options can vary by state and by plan, but you might explore:

1. Medicare Savings Programs (MSPs)

These state-run programs may help pay for Medicare Part A and/or Part B premiums and sometimes other costs. Although separate from Extra Help, qualifying for an MSP can sometimes lead to automatic or easier access to Extra Help later.

Contact your state Medicaid office or state benefits agency to ask about:

• Qualified Medicare Beneficiary (QMB)
• Specified Low-Income Medicare Beneficiary (SLMB)
• Qualifying Individual (QI) programs

2. State Pharmaceutical Assistance Programs (SPAPs)

Some states have their own prescription assistance programs that help:

• People with Medicare
• People with limited incomes who don’t qualify for Medicaid
• Certain disease-specific needs

Not every state offers these. To check, you can contact:

• Your state’s department of health
• Your Area Agency on Aging
• Your State Health Insurance Assistance Program (SHIP)

3. Patient Assistance Programs and Discount Options

Some drug manufacturers and nonprofit organizations offer:

• Discount cards
• Coupons
• Patient assistance programs for specific medications

These are not part of Medicare and may have their own rules. Be sure to:

• Confirm you are using legitimate programs
• Avoid providing bank information to unofficial sources

You can also ask your doctor or pharmacist if there are lower-cost alternatives that are covered by your current plan.

4. Reviewing or Changing Your Part D Plan

Sometimes, switching to a different Part D plan can lower your overall costs, especially if:

• Your current plan doesn’t cover your medications well
• Another plan’s formulary includes your prescriptions at lower tiers

During Medicare’s open enrollment periods or certain special enrollment periods, you may be able to review and change plans. A SHIP counselor can help you compare plans in your area.

Tips to Avoid Scams and Confirm You’re on an Official Channel

Because Extra Help involves sensitive personal and financial information, it’s important to protect yourself from scams.

Here are practical tips:

How to Verify You’re Using an Official Source

• Look for “.gov” in website addresses (for example, Social Security and Medicare official sites).
• When receiving a call:
  • Be cautious if someone calls you unexpectedly asking for your Social Security number or bank details.
  • You may choose to hang up and call back using the official number listed on your Medicare card or on an SSA letter.
• Official letters:
  • Usually arrive in clearly labeled envelopes from Social Security, Medicare, or your state agency.
  • Refer to your Medicare Number, not a random ID.

Common Red Flags

Be very careful if:

• Someone guarantees approval for Extra Help for a fee.
• You are asked to pay money upfront to “speed up” your application.
• A caller pressures you to share your full Social Security number, bank account, or credit card over the phone unexpectedly.
• A website:
  • Has a confusing address that does not end in .gov for federal programs
  • Lacks clear information about who runs it

If you are unsure, you can:

• Call the official Medicare helpline
• Call the Social Security Administration
• Ask a trusted local agency, such as your Area Agency on Aging or SHIP, to confirm where you should apply

Quick Reference: Extra Help at a Glance

Understanding how Extra Help for Part D works can make a big difference in your monthly budget and access to needed medications. If you think you might qualify, your best next step is to contact the Social Security Administration, Medicare, or a local counseling resource such as SHIP to get accurate, up-to-date guidance and begin the official process through the correct channels.