How to Apply for Medicare Extra Help

Medicare Part D covers prescription drugs, but the premiums, deductibles, and copays can still strain a tight budget. When you apply for Extra Help, you are requesting a federal subsidy formally known as the Part D Low-Income Subsidy (LIS) that lowers or eliminates those costs. According to the Social Security Administration (SSA), Extra Help is estimated to be worth roughly $5,000 or more per year for the people who receive it, though the exact value depends on the medications you take and the plan you choose.

The application is free, relatively short, and can be completed online in about 10 to 15 minutes. Yet many eligible Medicare beneficiaries never apply for Extra Help, leaving substantial benefits unclaimed each year. This guide walks you through every step for 2026 — from checking your eligibility and understanding a major recent expansion of the program, to submitting the application and knowing what happens next. It is general education, not financial or legal advice.

What Changed: Full Extra Help Now Reaches 150% of Poverty

This is the single most important update for anyone applying today. For years, Extra Help came in two tiers: a “full” subsidy for people with the lowest incomes and resources, and a smaller “partial” subsidy for those between roughly 135% and 150% of the federal poverty level. The Inflation Reduction Act changed that. Beginning January 1, 2024, the partial subsidy was eliminated, and everyone who qualifies up to 150% of the federal poverty level now receives the full Extra Help benefit.

In practical terms, as of 2026 there is one Extra Help benefit, and it is the generous one. If your income and resources fall within the limits, you get $0 or a greatly reduced premium, no deductible, and low fixed copays — not a reduced-but-still-significant partial subsidy. If you were told years ago that you only qualified for partial help, it is worth re-checking, because the rules that limited you may no longer apply. When in doubt, apply again; SSA re-evaluates each application.

Who Should Apply

Extra Help is available to people who have Medicare and have limited income and resources. The dollar thresholds are set by federal poverty guidelines and are adjusted every year, so treat the following 2026 figures as estimates and verify the current numbers with Medicare or SSA before relying on them.

• Income: As of 2026, the annual income limit is approximately $23,940 for an individual and about $32,460 for a married couple living together (these figures correspond to 150% of the federal poverty level and rise most years).
• Resources: Countable resources must fall below a limit that SSA adjusts annually — in recent years roughly $17,000+ for an individual and $34,000+ for a couple. Confirm the current figure, because it changes.

Resources include money in bank accounts, stocks, bonds, and real estate other than your primary home. Your home, one vehicle, personal belongings, and certain burial funds and life insurance are generally excluded from the resource calculation. Because the limits are indexed and the rules around what counts can be nuanced, borderline cases are worth submitting — it costs nothing to apply, and SSA evaluates each application individually.

Some People Qualify Automatically

You do not always need to fill out an application. Medicare “deems” certain people automatically eligible for Extra Help, which means you get it without applying. You are generally deemed eligible if you have:

• Full Medicaid coverage (you are “dual eligible” for both Medicare and Medicaid)
• Supplemental Security Income (SSI)
• Help from a Medicare Savings Program (MSP) paying your Part B premium

If any of these apply to you, watch for a notice from Medicare confirming your Extra Help. If you think you should have been deemed eligible but were not, that is a good reason to contact SSA or apply directly.

Benefits You Receive With Extra Help

Because the partial tier is gone, the benefits below now describe what qualifying beneficiaries receive as of 2026. Exact copay amounts are set by CMS and change each year, so the figures are approximate — verify the current amounts.

• Part D monthly premium reduced to $0 when you enroll in a “benchmark” plan (a plan priced at or below your region’s benchmark)
• No annual Part D deductible
• Low fixed copays — a few dollars for generic drugs and a modestly higher set amount for brand-name drugs, adjusted annually by CMS
• Protection from the old coverage gap, or “donut hole,” which has been eliminated for all Part D enrollees
• Reduced or $0 cost-sharing after your out-of-pocket spending reaches the annual limit

Extra Help also stacks on top of a broader Part D improvement. The Inflation Reduction Act created an annual cap on what any Part D enrollee pays out of pocket for covered drugs — set at $2,000 in 2025 and indexed upward in later years (verify the exact 2026 figure with Medicare). For someone taking several prescriptions, the combination of Extra Help plus this cap can turn an unaffordable medication list into a manageable one. See our overview of the Medicare Part D out-of-pocket limit for how that cap works.

How to Apply: Step by Step

You can apply for Extra Help through any of the channels below. All of them go through the Social Security Administration, and all are free. Choose whichever is most convenient.

Online Application (Fastest Method)

Go to the Extra Help application at ssa.gov and complete Form SSA-1020 electronically. The online application usually takes about 10 to 15 minutes and gives you confirmation that your submission was received. Have this information ready:

• Your Social Security number
• Date of birth and home address
• Information about your income sources (Social Security benefits, pension, wages, interest and dividends)
• The approximate value of your resources (bank balances, investments, real estate other than your home)
• Details about your current Medicare Part D plan, if you have one

By Phone

Call Social Security at 1-800-772-1213 (TTY 1-800-325-0778). A representative can walk you through the application and submit it for you. Phone lines are busiest early in the week and early in the morning, so calling later in the week may mean a shorter wait.

In Person

Visit your local Social Security office. Staff can help you complete the application and answer questions. You can find your nearest office using the locator at ssa.gov. Calling ahead to check whether an appointment is needed can save you time.

By Mail

You can request a paper Form SSA-1020, complete it by hand, and mail it back. This is the slowest route because it depends on postal delivery and manual processing, but it is a valid option if you prefer paper.

Documents That Can Speed Things Up

SSA does not always require supporting documents with the initial application, but having the following ready can help if verification is requested:

• Your most recent tax return or Social Security benefits statement (Form SSA-1099)
• Recent bank statements showing current balances
• Investment or retirement account statements
• Pension or annuity payment records
• Life insurance policy face-value information

If you are married and living with your spouse, both of your income and resource figures are evaluated together, so have your spouse’s financial information available as well.

What Happens After You Apply

After you submit, SSA reviews your income and resource information. Processing times vary but are often a few weeks, and online applications tend to move fastest. You will receive a determination letter by mail explaining the result.

• Approved: Your Part D plan is notified and your cost-sharing is adjusted. Because the partial tier no longer exists, an approval means the full Extra Help benefit. You also get a special enrollment opportunity to move to a $0-premium benchmark plan if you are not already in one.
• Denied: The letter explains why and outlines your appeal rights. The most common reasons are income or resources above the limit.

If you are approved, you generally do not need to contact your Part D plan separately — SSA transmits your eligibility to CMS, which notifies your plan.

What to Do If You Are Denied

A denial is not necessarily the end of the road. You typically have 60 days from the date of the denial notice to file an appeal, and during that time you can provide additional documentation or correct errors in your application.

If the denial was based on resources or income just over the limit, remember that the thresholds change each year — reapplying in a later year, or after a change in your circumstances, may produce a different result. You should not manipulate your finances to qualify, but ordinary spending on legitimate needs can naturally change your countable resources over time.

Also check whether you qualify for a Medicare Savings Program (MSP) through your state Medicaid office. Enrolling in an MSP can make you automatically eligible (“deemed”) for full Extra Help, which bypasses the separate SSA application entirely. This is one of the most useful and overlooked doors into the program.

Extra Help and Choosing the Right Part D Plan

Once you have Extra Help, choosing the right Part D plan still matters. Full Extra Help recipients who enroll in a benchmark plan pay $0 in premiums, and CMS publishes the benchmark plans by region each year. If you enroll in a non-benchmark plan, you may pay a small share of the premium.

Use the Medicare.gov Plan Finder to compare plans. Enter your medications and preferred pharmacies, and the tool estimates your total annual cost under each available plan, adjusted for your Extra Help level. Because formularies change every year, it is worth re-checking during Medicare’s fall Open Enrollment.

People with Extra Help also get extra flexibility to change plans. CMS provides Extra Help enrollees a special enrollment period that, in recent years, has allowed a plan change roughly once a month (an expansion from the older once-per-quarter rule). Because these enrollment rules can change, confirm the current frequency with Medicare before you rely on it — but the takeaway is that you are not locked in the way standard enrollees are.

Frequently Asked Questions

Can I apply for Extra Help at any time of year?

Yes. Unlike standard Part D enrollment, which has set periods, you can apply for Extra Help at any time. There is no deadline, and benefits can begin as early as the month after your application is approved.

Does owning a home disqualify me?

No. Your primary residence is excluded from the resource calculation regardless of its value. You can own a home and still qualify, as long as your other resources and your income fall within the limits.

Will Extra Help affect my Social Security benefits?

No. Extra Help is a separate program that reduces your prescription-drug costs. It does not change your Social Security retirement or disability benefits.

Do I have to be enrolled in Part D to apply?

You do not need to be enrolled in Part D before you apply, but you will need a Part D plan to actually use the benefit. If you are approved for Extra Help before enrolling, you receive a special enrollment period to sign up for a plan.

Is there still a “partial” Extra Help benefit?

No. As of 2024, the partial subsidy tier was eliminated. Everyone who qualifies up to 150% of the federal poverty level now receives the full benefit. This is a key reason to re-apply if you were only granted partial help in the past.

What if my income changes after I am approved?

SSA periodically reviews eligibility. If your income or resources rise above the limits, your Extra Help may be reduced or ended after that review. The program is designed to follow your circumstances over time.

For more ways to lower what you spend on care and prescriptions, explore our healthcare costs guide and our overview of the Medicare Part D out-of-pocket limit.

Sources

• Social Security Administration (SSA) — Extra Help with Medicare prescription drug plan costs; Form SSA-1020; helpline 1-800-772-1213
• Medicare.gov / Centers for Medicare & Medicaid Services (CMS) — Costs for Medicare drug coverage; Extra Help; Medicare Savings Programs; 1-800-MEDICARE
• Centers for Medicare & Medicaid Services (CMS) — Inflation Reduction Act changes to Part D and the Low-Income Subsidy