Medicare Part D

Extra Help Could Ease Your 2026 Medicare Drug Costs

VESTAVIA HILLS, Ala. — If prescription costs are stretching your monthly budget, there's a federal program that could quietly do a lot of the heavy lifting. It's called Extra Help, also known as the Low-Income Subsidy (LIS), and it helps people with Medicare pay for their Part D prescription drug coverage.

Many people who qualify never apply. Some assume their income is too high. Others don't realize the rules changed to let more people in. Here's what to know before you leave money on the table.

What Extra Help Actually Does

Extra Help is a federal benefit run through Social Security and the Centers for Medicare & Medicaid Services (CMS). It lowers what you pay for Medicare Part D, the part of Medicare that covers prescription drugs.

If you qualify, Extra Help can reduce or eliminate your Part D premium and deductible, and it caps what you pay at the pharmacy for covered generic and brand-name drugs. It also removes the late enrollment penalty for Part D if you didn't sign up when you were first eligible.

As of 2024, the program was expanded so that everyone who qualifies now gets the full subsidy — the old "partial" Extra Help level was eliminated. That change means more people get more help than before.

Who Qualifies in 2026

To get Extra Help, you must have Medicare and meet limits on income and resources. According to Social Security, in 2025 the limits were:

• Income: up to 150% of the federal poverty level (about $23,475 for an individual and $31,725 for a married couple living together — slightly higher in Alaska and Hawaii).
• Resources: up to $17,600 for an individual and $35,130 for a married couple. Resources include money in checking, savings, stocks, and bonds. Your home, one car, personal belongings, and burial plots don't count.

Those numbers are updated each year, so 2026 figures may shift a bit. Even if you're close to the limits — or you were denied in the past — it's worth applying again. Some income (like certain in-kind help from family) doesn't count the way people expect.

If you already have Medicaid, Supplemental Security Income (SSI), or a Medicare Savings Program, you automatically get Extra Help. You don't need to apply.

How Extra Help Fits with the New 2026 Part D Rules

Even without Extra Help, Part D looks different in 2026 than it did a few years ago:

• The out-of-pocket cap for covered drugs is $2,100 for the year.
• The maximum Part D deductible is $615.
• The old "donut hole" coverage gap was eliminated in 2025, so Part D now has three simpler phases.
• The Medicare Prescription Payment Plan lets anyone with Part D spread their yearly drug costs into monthly payments at no extra charge.

Extra Help sits on top of these protections. If you qualify, your costs are typically well below that $2,100 cap — often just a few dollars per prescription.

Common Mistakes to Avoid

A few missteps keep people from getting help they're entitled to:

• Assuming you make too much. The income limit is higher than many people think, and not every dollar counts.
• Skipping the application because you own a home or car. Your primary home and one vehicle don't count as resources.
• Not reapplying after a life change. Losing a spouse, retiring, or a drop in income can make you newly eligible.
• Confusing Extra Help with a Medicare Savings Program. They're different. MSPs help pay Part B costs; Extra Help is for Part D drugs. You may qualify for both.
• Missing enrollment windows. If you get Extra Help, you get more flexibility to change Part D plans during the year, but most people still use the Annual Enrollment Period (Oct. 15 – Dec. 7) to review coverage.

How to Apply from Vestavia Hills

Vestavia Hills is in Jefferson County, where Medicare beneficiaries have a wide range of stand-alone Part D and Medicare Advantage plans with drug coverage to choose from. Extra Help works with either type of drug coverage.

You can apply for Extra Help in a few ways:

• Online at ssa.gov/extrahelp
• By calling Social Security at 1-800-772-1213
• In person at a local Social Security office
• With free help from Alabama SHIP (State Health Insurance Assistance Program), which offers unbiased Medicare counseling at no cost

There's no fee to apply, and applying doesn't affect your other Social Security benefits.