Medicare Part D

Struggling with Rx bills in Mishawaka? Extra Help may cover most Part D costs

MISHAWAKA, Ind. — If prescription costs are stretching your budget, there is a federal program that can quietly do a lot of the heavy lifting. It is called Extra Help, also known as the Low-Income Subsidy, and it helps people with Medicare pay for their Part D prescription drug coverage. It works alongside the annual cap on what anyone with Part D pays out of pocket for covered drugs — $2,100 in 2026 and $2,400 in 2027 — but for people who qualify for Extra Help, the costs are far lower than that.

What Extra Help actually does

Extra Help is run by the Social Security Administration and pays a big share of your Part D drug plan costs. People who qualify pay no Part D premium and no deductible on a benchmark plan, and their copays for covered prescriptions are capped at low, set amounts. If you have Medicare and Medicaid, get Supplemental Security Income (SSI), or get help from a Medicare Savings Program, you automatically qualify — you do not need to apply.

For everyone else, it comes down to income and resources.

Who qualifies for Extra Help

To qualify for Extra Help, your income and savings must fall below limits set each year by the federal government. As a general guide from Medicare.gov, you may qualify if your yearly income is up to roughly $23,000 for a single person or about $31,000 for a married couple living together, and your resources (things like bank accounts and investments) are under about $17,600 single or $35,130 married. Your home, one car, and personal belongings do not count.

Even if you think you earn a little too much, it is worth applying. Social Security does not count everything you might expect, and rules changed in recent years to expand who is eligible.

How to apply

You can apply for Extra Help at any time — there is no enrollment window. There are three easy ways:

• Online at ssa.gov/extrahelp
• By calling Social Security at 1-800-772-1213 (TTY 1-800-325-0778)
• In person at your local Social Security office

The application is short. Social Security will send you a decision letter, and if you are approved, you can then join or switch to a Part D plan. If you already have a Part D plan, the subsidy will be applied to it.

How Extra Help fits with Part D changes in 2027

Even without Extra Help, Part D continues to look different than it did a few years ago. The old coverage gap (the “donut hole”) is gone as of 2025, replaced by three simpler phases. The maximum Part D deductible any plan can charge is $615 for 2026 and $700 for 2027, and the out-of-pocket limit on covered drugs is $2,100 in 2026 and $2,400 in 2027. There is also the Medicare Prescription Payment Plan, an optional program that lets you spread your drug costs across the year in monthly installments instead of paying at the pharmacy counter.

If you get Extra Help, most of those numbers become moot — your copays are already set at low fixed amounts.

Local context for Mishawaka

Mishawaka is in St. Joseph County, where residents have a wide selection of stand-alone Part D drug plans and Medicare Advantage plans that include drug coverage. Plan availability is set at the county level, so two neighbors in Mishawaka see the same choices. The Annual Enrollment Period runs Oct. 15 through Dec. 7 each year, and the Medicare Advantage Open Enrollment Period runs Jan. 1 through March 31. If you get Extra Help, you also have more flexibility to change drug plans outside those windows.

Where to get free, trustworthy help

You do not have to sort this out alone, and you should not pay anyone to file an Extra Help application. Free, unbiased counseling is available through Indiana’s State Health Insurance Assistance Program (SHIP). You can also call 1-800-MEDICARE (1-800-633-4227) or visit medicare.gov to compare drug plans once you know your status.