Medicare Part D

Extra Help Could Cut Antioch Seniors' Drug Costs in 2026

ANTIOCH, Calif. — For older adults juggling prescription bills, a federal program called Extra Help — also known as the Low-Income Subsidy, or LIS — can quietly do some of the heaviest lifting. And with Medicare's Part D rules continuing to shift into 2027, more Antioch residents may want to take a fresh look at whether they qualify.

Extra Help lowers what people with Medicare pay for their Part D prescription drugs, including premiums, deductibles, and copays. It's run through the Social Security Administration and Medicare, and it's separate from the drug plan itself.

What Extra Help Actually Does

Extra Help is a federal subsidy that reduces out-of-pocket costs for Medicare Part D drug coverage. According to CMS, people who qualify pay no Part D deductible, no more than a small set copay for covered generic and brand-name drugs, and no premium for a benchmark drug plan.

Since 2024, Extra Help has been a single, full-benefit program — the older "partial" tier was eliminated. That means if you qualify at all, you get the full subsidy.

Who Qualifies in 2026 and 2027

To get Extra Help in 2026, your income generally must be at or below 150% of the federal poverty level, and your resources (things like money in checking, savings, stocks, and bonds) must fall under the program's limits. Medicare updates these figures each year, and the 2027 limits will be posted on medicare.gov and ssa.gov when released.

You may automatically qualify — without applying — if you:

• Have both Medicare and full Medicaid (Medi-Cal in California),
• Get Supplemental Security Income (SSI), or
• Are in a Medicare Savings Program that helps pay your Part B premium.

Everyone else can apply directly through Social Security, online at ssa.gov, by phone at 1-800-772-1213, or at a local Social Security office.

Why 2027 Is a Good Year to Check

Big changes to Part D are still settling in. As of 2025, the old coverage gap (the "donut hole") is gone, replaced by a simpler three-phase design. For 2027, Medicare has set:

• A $2,400 annual out-of-pocket cap on covered Part D drugs in 2027 (up from $2,100 in 2026),
• A maximum Part D deductible of $700 in 2027 (up from $615 in 2026), and
• The optional Medicare Prescription Payment Plan, which lets you spread your drug costs across the year in monthly installments instead of paying big amounts at the pharmacy counter.

Extra Help sits on top of these protections. For someone who qualifies, the $2,400 cap in 2027 becomes a ceiling they're very unlikely to hit, because their copays are already limited to small fixed amounts.

How Extra Help Fits With Antioch's Local Coverage

Antioch is in Contra Costa County, where Medicare beneficiaries can choose from a range of stand-alone Part D drug plans and Medicare Advantage plans that include drug coverage. Extra Help can be used with either path, as long as the plan includes Part D benefits.

If you qualify for Extra Help and aren't already in a drug plan, Medicare can enroll you in one automatically so you don't go without coverage. You can also switch drug plans more often than most people — those with LIS get a Special Enrollment Period to change plans once per quarter during the first three quarters of the year.

Common Mistakes Worth Avoiding

A few missteps come up again and again:

• Assuming you make "too much." Many people who could qualify never apply because they guess wrong about the limits. Social Security encourages you to apply and let them do the math.
• Confusing Extra Help with Medi-Cal. They're different programs, though people on full Medi-Cal automatically get Extra Help.
• Missing the annual review. Your status can change if your income, household size, or resources change. Watch for letters from Medicare or Social Security on colored paper — those are important.
• Skipping the Annual Enrollment Period. From October 15 to December 7, 2026, you can review and change your Part D or Medicare Advantage coverage for 2027. If you have Medicare Advantage, there's also an Open Enrollment Period from January 1 to March 31, 2027.