Do I qualify for Extra Help with prescription costs?
Extra Help is the federal program that cuts what you pay for Medicare drug coverage. If you qualify, your plan premium can drop to $0, your deductible disappears, and each prescription costs a few dollars at most. The income limit is higher than most people expect, and Social Security counts less of your income than you might think.
Already applied? Read what happens after approval or a denial, including how to appeal within 60 days.
Quick answer for 2026. One person qualifies with countable income under $23,940 a year ($1,995 a month) and resources under $18,090. A married couple qualifies under $32,460 ($2,705 a month) and $36,100 in resources. You qualify automatically with full Medicaid, a Medicare Savings Program, or SSI.
2026 Extra Help Limits
Social Security subtracts $20 a month from most unearned income, such as a Social Security check, before comparing it with the limit. Medicare.gov lists the countable limit. If you want to compare your gross monthly income, add the $20 back.
| Household | Countable income, yearly | Countable, monthly | Gross monthly (add $20) | Resources |
|---|---|---|---|---|
| Single | $23,940 | $1,995 | about $2,015 | $18,090 |
| Married couple | $32,460 | $2,705 | about $2,725 | $36,100 |
The resource figures include a $1,500 burial allowance for each person. In other words, the amount you can hold in countable assets is $16,590 for one person and $33,100 for a couple, plus the burial allowance. Savings, stocks, bonds and retirement account balances are the kinds of things Social Security asks you to document. Ask Social Security what else counts before you rule yourself out.
Alaska and Hawaii. NCOA lists higher limits because the poverty level is higher there. In Alaska the gross limit is $2,514 a month for one person ($30,165 a year) and $3,401 for a couple. In Hawaii it is $2,315 for one person ($27,780 a year) and $3,131 for a couple.
Who Qualifies Without Applying
You qualify automatically if you have any of these:
- Full Medicaid. People with both Medicare and full Medicaid get Extra Help automatically.
- A Medicare Savings Program. If your state pays your Part B premium through QMB, SLMB or QI, you qualify. See the state by state guides to check your limits.
- Supplemental Security Income (SSI).
If you qualify automatically, you keep Extra Help through December 31 even if your income changes during the year. If you still meet the limits for next year, you keep receiving it, and you only get a notice if you no longer qualify or are moved to a different plan.
What You Pay With Extra Help in 2026
| Cost | With Extra Help |
|---|---|
| Monthly premium | $0 in a basic plan whose premium is at or below your state benchmark. The benchmark ranges from $0 in Alaska and New Mexico to $58.82 in New York. |
| Deductible | $0. Without Extra Help, a plan deductible can be up to $615. |
| Generic drugs | Up to $5.10 per prescription |
| Brand name drugs | Up to $12.65 per prescription |
| Full Medicaid, income under the poverty level | $1.60 generic and $4.90 brand |
| After the out of pocket cap | $0 for covered drugs once you reach $2,100 in the year |
You always pay the lower of the Extra Help copay or your plan's own copay. Extra Help can cut a Part D bill by thousands of dollars a year for someone who takes several brand name drugs.
How the Math Works
Say you receive $1,900 a month from Social Security and $100 from a small pension. That is $2,000 a month. Social Security subtracts $20, leaving $1,980, which is under the $1,995 single limit. If your savings are $14,000, you are also under the $18,090 resource limit, so you likely qualify. At $2,030 a month, the countable amount is $2,010 and you are just over. In that case, ask about the Medicare Savings Programs, because several states set higher limits than the federal floor.
How to Apply
- Gather documents. Social Security asks for bank statements, tax returns, IRA and 401(k) balances, and statements for pensions, Veterans benefits, annuities and Railroad Retirement benefits, for you and your spouse.
- Apply online or by phone. Use the Social Security Extra Help application, or call 1-800-772-1213 (Monday to Friday, 8 a.m. to 7 p.m. in most time zones) and ask for an appointment. TTY users can call 1-800-325-0778.
- Apply any time. You do not have to wait for open enrollment. You can apply before or after you enroll in a Part D plan, and you can reapply if your income or resources change.
- Ask for free help. Your State Health Insurance Assistance Program (SHIP) counselor can help you fill out the application at no cost.
Applying for Extra Help and a Medicare Savings Program at the same time is allowed. In some states, an Extra Help application also starts a Medicare Savings application, including Georgia, Montana, Idaho and Hawaii.
Open Enrollment Is Now
Medicare's fall open enrollment runs from October 15 to December 7. If you have Extra Help, review your plan now, because your premium is only $0 if your plan sits at or below the state benchmark. Medicare.gov also says people with Medicaid or Extra Help may be able to change their drug coverage once a month, so a poor fit does not have to last all year.
Coming in 2027. Medicare.gov already lists next year's Extra Help amounts: a $0 plan premium and deductible, up to $5.80 per generic drug and $14.40 per brand name drug, and $0 per covered drug after you reach $2,400. Limits for 2027 are not published on the pages we checked, so recheck in January.
Common Questions
What is the Extra Help income limit in 2026?
For one person, countable income must be under $23,940 a year, or $1,995 a month. For a married couple it is $32,460 a year, or $2,705 a month. Social Security subtracts $20 a month from most unearned income first, so your gross limit is about $2,015 single and $2,725 for a couple.
What is the Extra Help resource limit in 2026?
$18,090 for one person and $36,100 for a married couple. Those figures include a $1,500 per person burial allowance.
Do I qualify for Extra Help automatically?
Yes, if you have full Medicaid, help from your state paying Part B premiums through a Medicare Savings Program, or Supplemental Security Income. You do not need to apply.
How much do prescriptions cost with Extra Help in 2026?
Up to $5.10 for a generic drug and $12.65 for a brand name drug, with no plan deductible and a $0 premium in a plan at or below your state benchmark. If you have full Medicaid and income under the poverty level, the copays are $1.60 and $4.90. Once you reach the $2,100 out of pocket cap, covered drugs cost $0.
How do I apply for Extra Help?
Apply online on the Social Security website, or call 1-800-772-1213 and ask for an appointment. TTY users can call 1-800-325-0778. You can apply at any time, before or after you enroll in a Part D plan.
How long does Extra Help last if my income changes?
If you qualify automatically, you keep Extra Help through December 31 even if your income changes mid year. If you still meet the limits for next year, you keep receiving it.
Sources
- Social Security Administration: Extra Help with Medicare prescription drug plan costs
- Medicare.gov: Help with drug costs
- NCOA: 2026 Part D LIS eligibility and benefits chart (updated August 2026)
- Mass Legal Services: 2026 Medicare Part D cost sharing and Extra Help
- Medicare Interactive: Drug costs under Extra Help
Check If You Qualify
Run your numbers through the free estimators. They check Extra Help and your state's Medicare Savings limits together.