Medicare Part D

Extra Help Could Cut Salinas Seniors' Rx Costs in 2026

In Salinas, many older adults on Medicare quietly stretch their budgets each month to afford prescriptions. A federal program called Extra Help — also known as the Low-Income Subsidy, or LIS — was built for exactly that squeeze. It lowers what people with limited income and savings pay for their Part D drug coverage, and more Californians qualify than actually sign up.

What Extra Help actually does

Extra Help is a federal benefit run by Social Security and Medicare. If you qualify, it reduces or eliminates your Part D plan's monthly premium (up to a benchmark amount), lowers your deductible, and caps what you pay at the pharmacy counter for covered generic and brand-name drugs.

It works with whichever stand-alone Part D plan or Medicare Advantage plan with drug coverage you're enrolled in. You don't have to switch plans to use it — the subsidy follows you.

Who qualifies in 2027

Eligibility is based on income and resources (things like money in checking, savings, stocks, and bonds — your home and car don't count). According to CMS and the Social Security Administration, the general thresholds for 2025 applications are:

• Income at or below about 150% of the federal poverty level.
• Resources at or below roughly $17,600 for an individual, or $35,130 for a married couple living together (these limits are adjusted yearly).

If you already have Medicaid, Supplemental Security Income (SSI), or a Medicare Savings Program, you're automatically enrolled in Extra Help — you don't need to apply separately.

One important recent change: as of 2024, Congress eliminated the "partial" Extra Help tier. Everyone who qualifies now receives the full subsidy. If you were denied or got only partial help in past years, it's worth reapplying.

Where Salinas fits in

Salinas is in Monterey County, where Medicare beneficiaries choose among a range of stand-alone Part D and Medicare Advantage plans with drug coverage. Extra Help can be applied to plans available in the county — the subsidy itself is a federal benefit, not tied to any one insurer.

Monterey County also has a strong network of free, unbiased Medicare counselors through California's Health Insurance Counseling and Advocacy Program (HICAP), the state's SHIP. They can help you check whether you qualify and file the application at no cost.

How Extra Help works with Part D changes in 2027

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

• The annual out-of-pocket cap is $2,100 in 2026 and $2,400 in 2027. Once you hit that on covered drugs, you pay nothing more for the rest of the calendar year.
• The maximum Part D deductible is $615 in 2026 and $700 in 2027 (plans can set it lower).
• The coverage gap — the old "donut hole" — was eliminated in 2025. Part D now has three phases instead of four.
• The Medicare Prescription Payment Plan lets anyone with Part D spread their drug costs into monthly payments across the year, at no added charge.

For someone approved for Extra Help, those numbers matter less because copays are already reduced. But the out-of-pocket cap is a real safety net for people who don't qualify for LIS but still take expensive medications.

How to apply

There are three easy ways to apply, and all are free:

1. Online at ssa.gov/extrahelp. 2. By calling Social Security at 1-800-772-1213. 3. In person at a local Social Security office.

You can apply at any time of year — you're not locked into the fall Annual Enrollment Period (Oct. 15 – Dec. 7). If you're approved, you also get a Special Enrollment Period to switch Part D plans if a different one better fits your medications.

Watch out for scams. Social Security and Medicare will never call you out of the blue to ask for payment or your bank details to "enroll" you in Extra Help.