What Is Medicare Extra Help?

Medicare was created to help beneficiaries pay for health insurance and enjoy a more financially secure retirement once they leave employer-sponsored coverage. But what happens when low-income Medicare beneficiaries need additional support to cover all their health-related costs? Medicare Extra Help is designed for people with limited income and resources, helping them pay for Medicare drug coverage (Part D). The program, also known as the Low-Income Subsidy (LIS) helps cover out-of-pocket costs, like premiums, coinsurance, and deductibles.

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Are You Eligible for Extra Help?

Some people automatically qualify for Extra Help, while others have to apply to gain entrance to the program. Your income and resources are used to determine your eligibility and the level of help you receive.

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You’ll automatically receive Extra Help if you:

• Are enrolled in or eligible for both Medicare and your state’s Medicaid program: Some beneficiaries are enrolled in both programs due to their income level or life circumstances, such as a severe disability. An individual already receiving Medicare may be enrolled in Medicaid by a state agency if they also receive Supplemental Nutrition Assistance Program (SNAP) benefits or Supplemental Security Income (SSI).
• Participate in a Medicare Savings Program (MSP): These programs allow enrollees to get help with their Part A and Part B expenses from their state. If you don't know what the Medicare Savings Program is, here is an overview of the four MSPs with different eligibility criteria and benefits.
• Have Medicare and also have limited income and assets: Depending on your resources and marital status, you may be eligible for full or partial assistance with premiums, deductibles, copays, and out-of-pocket drug costs.

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If you aren’t sure about your eligibility or know you don’t automatically qualify for Medicare Extra Help, talk to your Medicare advisor. Their job is to make sure you have access to all the programs and benefits you’re entitled to.

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Should You Apply?

If you don’t meet the automatic enrollment criteria but still need help with Medicare drug costs, you have the option of applying for Medicare Extra Help as long as you meet some basic criteria:

• You have Medicare Part A and/or Medicare Part B.
• You live in one of the 50 states in the United States or the District of Columbia.
• You’re a single individual or not currently living with your spouse and have savings, investments, and real estate worth less than $16,000.
• You’re married and living with your spouse and have savings, investments, and real estate worth less than $33,240.
• Your 2023 income is less than $21,870 for an individual or $29,580 for a married couple. 

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Even if you don’t qualify for Medicare Extra Help, you can still enroll in a Medicare prescription drug plan. Your Medicare advisor can help you find an affordable plan, and your doctor may be able to switch you to a generic medication or help you enroll in a state-run or manufacturer-run pharmaceutical assistance program to defray the cost of your prescription.

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What Are the Benefits of Medicare Extra Help?

If you’re eligible for the Medicare Extra Help program, you will pay no more than $11.20 for brand-name drugs and $4.50 for generic drugs. For those who are also eligible for Medicaid, copays are set at $4.60 for brand-name drugs and $1.55 for generic drugs. 

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Also, Medicare Extra Help enrollees receive financial assistance with Part D plan deductibles. Depending on your income, your deductible will be reduced or waived altogether. 

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As for the actual cost of Part D coverage, the federal government pays a portion of the premium. The amount depends on which state you live in. 

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If you have questions about Medicare Extra Help or Medicare in general, we’re here to help. Contact us via phone or text at (888) 443-5336 (TTY: 711) to consult with a licensed Medicare agent. You can also browse our advisor directory to find an advisor who serves your state. 

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We do not offer every plan available in your area. Currently we represent 22 organizations which offer 2,824 products in your area. Please contact Medicare.gov, 1–800–MEDICARE, or your local State Health Insurance Program to get information on all of your options.