Part of our Medicare and Medicaid Help for Families guide
Extra Help for Medicare Drug Costs: Who Qualifies and How to Apply
Picture this: at the pharmacy counter, Dad quietly asks which of his three prescriptions he could skip this month. That question is exactly what Extra Help was built for.
Extra Help is a Medicare program that lowers Part D drug costs. For 2026, a single person qualifies with income under $23,940 and resources under $18,090; a married couple, under $32,460 and $36,100. People with full Medicaid, a Medicare Savings Program, or SSI get it automatically. Everyone else applies free with Social Security.
This guide is for US families helping a parent with drug bills during Open Enrollment or any time of year. You get the 2026 limits on one card, a "does it count?" quiz using a made-up example, a step by step application walkthrough, myth vs fact cards, and a free one-page prep sheet.
Did you know? The $18,090 resource limit you see everywhere already includes $1,500 that Social Security sets aside for funeral or burial costs. Its staff manual says the base limit for 2026 is $16,590, and the $1,500 is added unless the person says none of their savings will go to burial. So answer the burial question on the application carefully. SSA POMS HI 03030.025
What are the Extra Help income limits for 2026?
Medicare.gov lists the 2026 limits as yearly income under $23,940 for one person or $32,460 for a married couple, and resources under $18,090 for one person or $36,100 for a couple. Income limits are higher in Alaska and Hawaii. These limits may go up each year, so check the current year before applying.
These are the figures on Medicare.gov's Help with drug costs page and in the CMS flyer Save on your Medicare drug costs with Extra Help (April 2026):
| Who | Yearly income under | Resources under | Monthly income, roughly (our math) |
|---|---|---|---|
| Single person | $23,940 | $18,090 | about $1,995 |
| Married couple living together | $32,460 | $36,100 | about $2,705 |
A few things about whose money counts, straight from Social Security's handbook:
- Only Mom, plus a spouse she lives with. If she is single, or married but not living with her spouse, Social Security counts only her income (SSA Handbook 2604).
- Your help with the bills is not income. Social Security does not count help someone else gives with food, rent, mortgage, utilities, or property taxes (SSA Handbook 2603).
- The year ahead matters. It looks at the countable income she gets, or expects to get, during the year being decided.
When we built our Extra Help organizer, we left the limits as blanks to fill in rather than printing them, because they can change every year. Do the same on your own notes: write the year next to every number.
What counts as a resource for Extra Help?
Resources are money and things that can be turned into cash: checking and savings accounts, CDs, stocks, bonds, mutual funds, IRAs, 401(k)s, cash at home, and real estate other than her home. Her home, one car, furniture, personal items, life insurance policies, burial plots, and up to $1,500 set aside for burial do not count.
The "counts" list comes from the CMS flyer and SSA Handbook 2609, which counts anything that can be turned into cash within 20 workdays. The "does not count" list comes from the CMS flyer and SSA Handbook 2612. The life insurance line surprises most families: the handbook excludes life insurance policies for Extra Help, even though the SSI program treats some policies differently.
Count it like Social Security: a made-up example
Picture this example: Dad is a widower. He owns his paid off house and a 2015 sedan. Tap each item to see whether Social Security would count it.
$4,200 in his checking account
Counts. Bank accounts are resources. Use the balance on his latest statement.
$9,000 in an old IRA from his job
Counts. Retirement accounts like IRAs and 401(k)s are on Social Security's countable list.
His paid off house
Does not count. The home he lives in is excluded, including the land and outbuildings.
His 2015 sedan
Does not count. The CMS flyer says one car is not a resource.
A whole life insurance policy with some cash value
Does not count. SSA Handbook 2612 lists life insurance policies as excluded for Extra Help.
$1,500 in an envelope labeled "for my funeral"
Does not count, if he set it aside for burial. Up to $1,500 for one person ($3,000 for a couple) is excluded for burial expenses.
Your savings account, since he lives with you now
Does not count. Social Security does not count the resources of relatives who live with the person applying (SSA Handbook 2610).
Dad's total: $4,200 plus $9,000 is $13,200 in countable resources. That is under the 2026 limit of $18,090, so resources would not stop him. Next, Social Security looks at his income. This is an example only; Social Security makes the real decision.
Who gets Extra Help automatically?
Medicare.gov says people who get full Medicaid, a Medicare Savings Program that pays the Part B premium, or Supplemental Security Income (SSI) get Extra Help automatically. They do not need to apply. They get a notice in the mail saying what they will pay and which drug plan they are in, if they did not have one.
If Mom already has one of those three, look for that notice instead of filling out an application. If she is not sure, call 1-800-MEDICARE (1-800-633-4227, TTY 1-877-486-2048) and ask what level of Extra Help she has.
How do you apply for Extra Help?
Apply with Social Security, for free. Go online at ssa.gov/extrahelp, or call 1-800-772-1213 (TTY 1-800-325-0778) and ask for an appointment to apply for Part D Extra Help. Gather bank statements, tax returns, retirement account balances, and pension or benefit statements first. Your local SHIP can help for free.
Applying is free. You never need to buy anything or pay anyone to apply: Social Security takes the application and helps with it at no cost (Social Security: Apply for Extra Help). You can apply any time, before or after joining a Part D plan.
Step 1: Check the automatic list
Full Medicaid, a Medicare Savings Program, or SSI? Then she already has Extra Help. Skip to step 5.
Step 2: Gather the papers
Social Security's own list, for her and her spouse: bank statements and tax returns; IRA or 401(k) balances; and statements for pensions, veterans' benefits, annuities, and Railroad Retirement Board benefits.
Step 3: Apply online or by phone
Apply online at ssa.gov/extrahelp, or call 1-800-772-1213, Monday through Friday, 8 a.m. to 7 p.m. in most US time zones, in English, Spanish, and other languages. For free one-on-one help, find your State Health Insurance Assistance Program at shiphelp.org.
Step 4: Watch for the letter
Social Security mails a letter saying whether she qualifies. Keep it with her Medicare card. Her plan may ask for proof of Extra Help later.
Step 5: Make sure she has a drug plan
Medicare.gov says that if she qualifies and has no drug plan, Medicare enrolls her in one so she gets the savings. She can pick a different plan. The CMS flyer warns she may pay more if the plan she picks does not offer a $0 premium and deductible for people with Extra Help.
Did you know? One application can start two. Medicare.gov says Social Security sends your Extra Help information to your state to start a Medicare Savings Program application, which can help with other Medicare costs, unless you tell it not to on the Extra Help application. Medicare.gov: Help with drug costs
What does Extra Help change at the pharmacy in 2027?
Medicare.gov says people with Extra Help in 2027 pay a $0 plan premium and $0 deductible, up to $5.80 for each generic and up to $14.40 for each brand-name drug at a participating pharmacy, and $0 per covered drug once total drug costs reach $2,400. People with full Medicaid and QMB pay no more than $4.90.
| Cost | With Extra Help |
|---|---|
| Plan premium | $0 in a plan that offers it to people with Extra Help |
| Plan deductible | $0 |
| Each generic drug | Up to $5.80 |
| Each brand-name drug | Up to $14.40 |
| After total drug costs reach $2,400 | $0 per covered drug |
| Full Medicaid plus QMB | No more than $4.90 per covered drug |
Not eligible, but the cost comes in big lumps? The Medicare Prescription Payment Plan can spread the same costs into monthly bills. It doesn't lower them, so check Extra Help first.
That is why Extra Help belongs in the Open Enrollment conversation. When you compare plans on Medicare Plan Finder between October 15 and December 7, check that the plan offers the $0 premium for people with Extra Help, and enter every drug she takes.
Extra Help also loosens the calendar. Medicare.gov's Special Enrollment Periods page says people with Extra Help can make a drug coverage change once a calendar month, starting the first of the next month: switch drug plans, or leave a Medicare Advantage plan with drug coverage for Original Medicare plus a standalone drug plan. That window is not available to someone a plan has flagged as an "at-risk beneficiary" under a drug management program.
Paying the wrong amount?
If the pharmacy charges more than the Extra Help amounts, Medicare.gov says to contact the drug plan, which may ask for proof of Extra Help, and tell them how many days of medicine are left. Or call 1-800-MEDICARE, which can tell you her level of Extra Help and help fix it with the plan.
Tap to tick, your progress saves on this device
Myth or fact: what stops families from applying?
Mostly wrong guesses. Families assume the house disqualifies Mom, that their own savings count because she lives with them, that applying costs money, or that it is not worth it for a few prescriptions. Each of those is wrong for most people. Tap each card to check the official answer before you decide not to apply.
Myth: owning a house means Mom will not qualify.
Fact: the home she lives in does not count as a resource. Neither does one car or her personal belongings.
Myth: she lives with us, so our savings count against her.
Fact: Social Security counts only her resources, plus a spouse she lives with. Relatives who live with her are not counted.
Myth: you have to pay someone to apply.
Fact: applying is free with Social Security, online or by phone, and SHIP counselors help for free too.
Myth: once she has Extra Help, she is stuck with the drug plan Medicare picked.
Fact: she can pick a different plan, and people with Extra Help can change drug coverage once a calendar month.
Myth: her life insurance policy will push her over the limit.
Fact: SSA Handbook 2612 lists life insurance policies as excluded for Extra Help.
Myth: if she is turned down once, that is the end.
Fact: she can appeal by phone hearing or case review, and Medicare.gov says she can reapply any time her income or resources change.
Where can we get free help applying for Extra Help?
Start with your State Health Insurance Assistance Program at shiphelp.org. SHIP counseling is free, local, and not tied to any insurance company. Social Security answers Extra Help questions at 1-800-772-1213, and 1-800-MEDICARE helps with drug plans and pharmacy problems. Bring the prep sheet to every call.
Shopping plans this fall? Our Medicare Open Enrollment checklist walks through the October 15 to December 7 window, and the Annual Notice of Change decoder shows what to circle on the fall letter, including drug list changes. If a letter says her Medicare Advantage plan is ending, read what to do when a Medicare Advantage plan is ending, because she will need a drug plan lined up. Did the pharmacy say the plan won't cover a drug at all? Read the pharmacy said no: how to ask for a Part D coverage determination for the request to make, the 72 and 24 hour deadlines, and a free call sheet. Is the Part B premium squeezing her budget too? Read Medicare Savings Programs: help paying the Part B premium for the four programs, the 2026 limits, and how to apply with your state. For the bigger picture, start at our Medicare and Medicaid help hub. For the full plan comparison, our Medicare Open Enrollment Kitchen Table Kit has drug and doctor grids laid out.
Want the paperwork already laid out? Our Cut Your Part D Bill: Extra Help Organizer is a 14-page printable for this exact job: an automatic-qualification check, a page to write in the current limits, income and resource inventory pages, application prep, and a decision letter tracker. It does not include any government form, and you never need it to apply: Social Security takes Extra Help applications and helps with them for free at ssa.gov or 1-800-772-1213. Get it on Gumroad for $12.99 (price checked October 22, 2026) or see it on Etsy.
Frequently asked questions
Is the Extra Help income limit monthly or yearly?
Yearly. Medicare.gov lists the 2026 limits as $23,940 for one person and $32,460 for a married couple. Divided by 12, that is about $1,995 a month for one person and about $2,705 for a couple. That monthly figure is our own math, so use the yearly number when you compare.
If Mom lives with us, does our income or savings count?
No. Social Security counts only her income and resources, plus her spouse's if they are married and living together. Its handbook says it does not count the resources of relatives who live with the person applying. Help you give her with rent, food, or utilities is not counted as income either.
What if Dad paid full price at the pharmacy before Extra Help started?
Keep the receipts. Medicare.gov says its Limited Income Newly Eligible Transition (LI NET) program gives temporary drug coverage to people who qualify for Extra Help but are not in a drug plan yet, and you may get some money back for covered drugs bought after he qualified. Call LI NET at 1-800-783-1307 (TTY 711).
Does Extra Help stop on December 31?
Not usually. Medicare.gov says Extra Help lasts through December 31 even if income changes mid year, and continues next year if you still meet the limits. You get a notice only if you no longer qualify or are moved to a different plan. Losing it opens a 3 month window to change plans.
Can Mom get Extra Help in Puerto Rico or the U.S. territories?
No. Medicare.gov says Extra Help is not available in Puerto Rico, the U.S. Virgin Islands, Guam, the Northern Mariana Islands, or American Samoa. Those areas have other programs for people with limited income and resources, and they vary. Call the State Medical Assistance (Medicaid) office there to ask what is offered.
What if Social Security says no?
You can appeal. Social Security says the Extra Help appeal is one step: a hearing by phone or a case review of the file. Call 1-800-772-1213, visit an office, or use form SSA-1021. If income or savings drop later, Medicare.gov says you can reapply any time.
Please note: This guide explains official rules in plain English. It is not legal or insurance advice and we are not affiliated with Medicare, Social Security, or any government agency. Confirm details with Social Security (1-800-772-1213), Medicare (1-800-MEDICARE), your State Health Insurance Assistance Program (SHIP), or an elder law attorney.
Sources
- Medicare.gov: Help with drug costs (Extra Help, 2026 limits, 2027 costs, LI NET). Checked 2026-10-22 (2026 limits and 2027 cost amounts copied from this page)
- CMS: Save on your Medicare drug costs with Extra Help (Product No. 12200). Checked 2026-10-22 (April 2026 edition)
- Social Security: Apply for Medicare Part D Extra Help. Checked 2026-10-22
- SSA POMS HI 03030.025: Resource limits for subsidy eligibility (2026, burial exclusion note). Checked 2026-10-22
- SSA Handbook 2609 and 2612: What are resources, and resource exclusions. Checked 2026-10-22
- SSA Handbook 2603, 2604, 2610: What is not income, whose income and resources count. Checked 2026-10-22
- SSA Handbook 2614: Extra Help appeals. Checked 2026-10-22
- Medicare.gov: Special Enrollment Periods (Extra Help monthly change, losing Extra Help). Checked 2026-10-22
- SHIP: State Health Insurance Assistance Programs. Checked 2026-10-22
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Keep reading
- Medicare Savings Programs: Help Paying the Part B Premium
- The Pharmacy Said No: How to Ask for a Part D Coverage Determination
- The Medicare Prescription Payment Plan: Spreading Drug Costs Across the Year
- Medicare Open Enrollment: A Kitchen-Table Checklist for Helping a Parent
- Your Medicare Plan's Annual Notice of Change: What to Check Before December 7
- Medicare and Medicaid Help for Families: start here
- Got a NOMNC? How a Medicare Fast Appeal Works
- Mom's Medicare Advantage Plan Is Ending or Her Doctor Left: What Now?
- Leaving Medicare Advantage: How the Medigap Trial Right Works
- Medicaid Look-Back Period in Plain English: Myths vs Facts
- Who to Notify When Someone Dies: A Printable US Checklist
- How to Prepare for an IEP Meeting: A Parent's Countdown Checklist
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