Do I Qualify for Extra Help With Medicare Prescription Costs?

Extra Help is a federal program that lowers what people with limited income and savings pay for Medicare prescription drug coverage. If your yearly income is under $23,940 for one person or $32,460 for a married couple, and your savings and investments are under $18,090 or $36,100, you likely qualify.

Those are the 2026 limits published by Medicare.gov. Social Security decides, not your drug plan and not me, and applying is free.

I'm a Medicare agent in Hawkins County, TN. Social Security's own booklet on Extra Help says many people are eligible and don't know it, so it's worth checking before you decide the limits rule you out.

01What does Extra Help actually do?

Social Security's booklet on Extra Help, publication 05-10508, describes it as help with the costs tied to a Medicare drug plan. How much you get depends on your situation, and the decision letter spells it out.

You won't pay the Part D late enrollment penalty while you're getting Extra Help. If you went without drug coverage for a stretch and picked up a penalty, it's set aside for as long as you qualify.

Avoiding that penalty in the first place turns on whether your other drug coverage is creditable. That's the question to sort out if you're still working at 65.

Extra Help also opens a Special Enrollment Period. Under 42 CFR 423.38, people who qualify can switch drug plans once per calendar quarter through September, on top of the fall enrollment period.

02What counts toward the limits, and what doesn't?

Resources means money you could get your hands on. Social Security counts checking and savings accounts, certificates of deposit, stocks, bonds, mutual funds, IRAs, cash, and real estate other than your home.

The same booklet lists what stays out of the count: the home you live in, your belongings, your vehicles, life insurance policies, and money set aside for burial. The house and the truck don't count against you.

Income has exclusions too. Social Security doesn't count SNAP benefits, housing assistance, home energy assistance, or earned income tax credit payments.

Being over the income limit isn't automatically a no, either. Social Security lists situations where you can earn more and still qualify, including if you're still working or supporting family members who live with you.

If you're anywhere near the line, apply and let them run the numbers.

Not sure how this applies to your own situation? I'll walk through it with you. No cost for the help, and no obligation to enroll.

Logan Cope · Licensed Insurance Agent

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03Do I already have Extra Help without knowing it?

Some people do. According to Medicare.gov, you get Extra Help automatically if you have full Medicaid coverage, if your state helps pay your Part B premium through a Medicare Savings Program, or if you get Supplemental Security Income.

If that's you, a notice comes in the mail telling you what you'll pay and which drug plan you're in. You don't apply for anything.

Full Medicaid being one of those doors is why the Medicaid work requirement brought questions from people on Medicare this summer. If you're enrolled in Medicare, that rule doesn't apply to you.

04What if I applied before and got turned down?

Apply again.

The limits move most years, and so do your income and savings. A denial from a few years back says nothing about this year.

The program changed, too. Under the Inflation Reduction Act, starting in January 2024, everyone who meets the limits gets the full level of Extra Help. The reduced level that used to apply at the top of the income range is gone.

05How do I apply?

1. Gather your income and what you own, for you and your spouse if you're married and living together.
2. Apply online at ssa.gov/medicare/part-d-extra-help, call Social Security at 1-800-772-1213, or go into a Social Security office.
3. Let the Medicare Savings Program application ride along. Social Security forwards your information to the state automatically unless you tell them not to on the form.
4. Watch for the decision letter. Social Security gives you 60 days to appeal if it's a no and you disagree.

Your pharmacy can't sign you up for this, and neither can a drug plan. Apply through Social Security.

Free help with the application is also available from Tennessee's State Health Insurance Assistance Program, listed at Medicare.gov.

The figures and rules above come from Medicare.gov and Social Security's Extra Help booklet, publication 05-10508.