What Extra Help Does

Extra Help is a federal program that pays part or all of your Medicare prescription drug costs if your income and savings fall below certain limits. The program covers the monthly premiums for a Part D plan, the yearly deductible you have to pay before coverage kicks in, and a portion of what you pay for each prescription at the pharmacy. You do not have to choose a special plan to use it — you enroll in any standard Part D plan, and Extra Help reduces what you owe.

The program is run by Social Security and the Centers for Medicare & Medicaid Services (CMS). If you meet the income and resource limits, you can receive Extra Help automatically if you already receive Supplemental Security Income (SSI) or certain other benefits. Otherwise, you have to request it through Social Security.

Key Takeaways

  • Extra Help covers Part D premiums, deductibles, and copayments for people with income below roughly 150% of the federal poverty line, though the exact limit changes each year.
  • If you receive SSI or certain other benefits, Social Security will enroll you in Extra Help without you having to ask.
  • You can request Extra Help by calling Social Security at 1-800-772-1213, completing an application online at ssa.gov, or applying in person at your local Social Security office.
  • Your savings and other resources matter — the program has limits on how much money you can have in the bank or own in assets.
  • Extra Help is reviewed once a year, and your benefits can change if your income or resources increase.

Income and Resource Limits

To receive Extra Help, your income must fall below a threshold that changes each year. The limit is roughly 150% of the federal poverty line, but the exact dollar amount depends on your household size and where you live. For 2024, a single person's monthly income limit is around $1,550, though this varies slightly by state. A married couple living together has a higher limit. You should contact Social Security directly to learn the current limit for your situation, since these numbers shift annually.

The program also limits how much money and property you can own. For a single person, the resource limit is typically around $8,000; for a married couple, it is roughly $12,000. These limits include savings accounts, stocks, bonds, and other liquid assets, but they do not count your home, your car, or certain other possessions. If your resources exceed the limit, you will not be found to meet the program's requirements.

Who Gets Extra Help Automatically

If you already receive Supplemental Security Income (SSI), you do not have to do anything — Social Security will enroll you in Extra Help automatically. The same applies if you receive certain state assistance programs. Social Security will send you a notice explaining your Extra Help benefits and which Part D plan you have been enrolled in.

If you do not receive SSI or other may have access to benefits, you will need to request Extra Help yourself. Even if you think you might not meet the income limit, it is worth applying, because the actual thresholds are higher than many people expect and the program rules can be more flexible than they first appear.

How to Request Extra Help

You can request Extra Help in three ways. The fastest is usually to call Social Security at 1-800-772-1213 and ask to apply. Have your Social Security number, birth date, and information about your income and resources ready. Social Security staff can often complete the application over the phone and tell you on the spot whether you meet the income and resource limits.

You can also apply online at ssa.gov by going to the Extra Help section and filling out the application form. This route lets you work at your own pace and attach documents, but you will have to wait for Social Security to contact you with a decision. A third option is to visit your local Social Security office in person and apply with help from a staff member. Bring documents that show your income (tax returns, pay stubs, benefit statements) and your resources (bank statements, investment account statements).

Social Security will review your application and send you a notice with the decision. If you are found to meet the requirements, you will receive information about which Part D plan you have been enrolled in and what your copayments will be. The process usually takes two to four weeks.

What Extra Help Pays For

Extra Help covers three main costs. First, it pays your Part D plan premium — the monthly fee you pay to have prescription drug coverage. Depending on your income, you might pay nothing, or you might pay a small portion while Extra Help covers the rest. Second, it covers your yearly deductible, which is the amount you have to pay out of your own pocket before the plan starts to pay. Third, it reduces your copayments — the fixed amount you pay for each prescription.

The exact copayment amounts depend on your income level. People with the lowest incomes pay $0 or $1 per prescription. Those with higher incomes (but still below the Extra Help limit) pay more, typically $3 to $5 per generic drug and $7 to $10 per brand-name drug. These amounts are set by the federal government and do not change based on which Part D plan you choose.

How Extra Help Interacts with Other Coverage

If you have other prescription drug coverage — from a former employer, a union, or Medicaid — Extra Help will work alongside it rather than replace it. The programs coordinate to make sure you do not pay twice for the same prescription. You should tell Social Security about any other coverage you have when you apply, so they can coordinate benefits correctly.

If you are also may be able to access for Medicaid, both programs may cover your prescriptions. Medicaid will typically pay first, and Extra Help will cover costs that Medicaid does not. The coordination between these two programs is complex, so ask your state Medicaid office or Social Security to explain how your specific situation will work.

Annual Review and Changes to Your Benefits

Social Security reviews your Extra Help benefits once each year, usually in the fall. If your income or resources have changed, your benefits may increase, decrease, or end. Social Security will send you a notice telling you whether your benefits are staying the same or changing. If your income has gone up, you might move to a higher copayment tier or lose Extra Help entirely. If your income has gone down, your benefits might improve.

You should report major changes to Social Security right away rather than waiting for the annual review. If you get a raise, lose a job, get married, or have another significant change in your financial situation, contact Social Security at 1-800-772-1213 to let them know. Reporting changes promptly helps prevent overpayments or underpayments and keeps your benefits accurate.

Frequently Asked Questions

Do I have to enroll in a specific Part D plan to use Extra Help?

No. You can enroll in any Part D plan offered in your area, and Extra Help will work with whichever plan you choose. The copayment amounts are the same across all plans if you have Extra Help, so you can pick based on which pharmacies you prefer or which drugs the plan covers best.

What if my income goes above the limit after I am already receiving Extra Help?

Social Security will discover the change during your annual review and may reduce or end your benefits. If the increase is temporary or small, you might still may have access to. Report the change to Social Security so they can recalculate your benefits accurately rather than waiting for the review.

Can I use Extra Help if I also have Medicare Advantage?

No. Extra Help only works with Original Medicare and a separate Part D plan. If you have a Medicare Advantage plan that includes drug coverage, you cannot use Extra Help. You would have to switch to Original Medicare and enroll in a Part D plan to become may be able to access.

What documents do I need to prove my income?

Bring recent tax returns, pay stubs, benefit statements (Social Security, SSI, pensions), or bank statements showing deposits. If you are self-employed, bring your business tax return. Social Security will tell you which documents they need based on your situation.

Can I appeal if Social Security denies my Extra Help request?

Yes. Social Security will include appeal instructions in the denial notice. You can request reconsideration, and if you disagree with that decision, you can request a hearing before an administrative law judge. You have 60 days from the notice date to file an appeal.