Medicare Part D

Extra Help for Medicare Part D: Elgin eligibility rules

ELGIN, Ill. — If you're on Medicare and the price of your prescriptions keeps you up at night, there's a federal program that doesn't get talked about enough: Extra Help, also called the Low-Income Subsidy, or LIS.

A quieter way to lower prescription costs

Extra Help is a benefit from Social Security and Medicare that lowers what you pay for a Part D drug plan — the monthly premium, the yearly deductible, and the cost at the pharmacy counter. It's not a discount card, and it's not a private offer. It's a program run through Medicare, and if you qualify, the savings continue year after year for as long as you remain eligible.

Elgin is in Kane County, where residents have several stand-alone Part D drug plans and Medicare Advantage plans with drug coverage to choose from. Extra Help works alongside those plans, no matter which one you pick.

What Extra Help actually does

The Part D out-of-pocket cap is $2,100 in 2026 and rises to $2,400 in 2027. The Part D deductible can't be more than $615 in 2026 or $700 in 2027. Those limits apply to everyone on a Part D plan. Extra Help goes further for people with limited income and savings.

People who qualify for full Extra Help pay:

• No Part D plan premium (up to a benchmark amount set by Medicare)
• No yearly deductible
• Only small, set copays for covered generic and brand-name drugs at the pharmacy

The coverage gap — the old "donut hole" — was eliminated in 2025, so Part D now has just three simple phases. Extra Help lowers your costs inside that structure.

Who qualifies for Extra Help

Extra Help is based on your income and your resources (things like money in checking, savings, and most investments). The income limit is tied to the federal poverty level and is updated each year.

As a rough guide, you may qualify if:

• Your yearly income is at or below roughly 150% of the federal poverty level, and
• Your resources fall under the limits Medicare sets each year (your home, one car, and personal belongings don't count).

As of 2024, Congress expanded Extra Help so that everyone who qualifies now gets the full benefit — the old "partial" tier is gone. That's a meaningful change for people who used to fall just over the line.

You automatically get Extra Help if you have:

• Medicaid (called Medical Assistance in Illinois),
• A Medicare Savings Program that helps pay your Part B premium, or
• Supplemental Security Income (SSI).

If none of those apply, you still have to file a short application.

How to apply from Elgin

There are three ways to apply, and all of them are free:

1. Online at ssa.gov/extrahelp. 2. By phone — call Social Security at 1-800-772-1213. 3. In person at your local Social Security office. The Elgin office is on Randall Road; call ahead for an appointment.

You can also get one-on-one, unbiased help from Illinois SHIP (the Senior Health Insurance Program), which has trained counselors across Kane County. They don't sell anything and they don't earn commission. Call 1-800-252-8966 to be connected with a counselor near Elgin.

Have a general idea of your income, your savings, and any pensions or investments before you start. The application itself takes about 10–15 minutes.

What happens after you're approved

Once Social Security approves you, Medicare will link Extra Help to whatever Part D plan you have. If you're not enrolled in a plan, Medicare will place you in one so you have coverage — but you can switch. People with Extra Help get a Special Enrollment Period and can change drug plans once per quarter during the first three quarters of the year, on top of the regular Annual Enrollment Period (October 15 – December 7).

That flexibility matters. If your medications change, or a plan drops a drug you take, you don't have to wait a full year to move.

A few things people miss

• Applying doesn't hurt you. There's no penalty for applying and being turned down, and you can reapply if your finances change.
• Extra Help is separate from Medicaid. You can qualify for Extra Help even if you don't qualify for Medicaid.
• It may erase your late-enrollment penalty. If you owe a Part D late-enrollment penalty, Extra Help wipes it out for as long as you have the subsidy.
• The Medicare Prescription Payment Plan is different. That's a new option that spreads your drug costs into monthly payments across the year. It doesn't lower your costs — Extra Help does.