Medicare Part D

Extra Help explained for Sterling Heights Medicare enrollees

STERLING HEIGHTS, Mich. — If prescription costs feel heavier than they should, there's a federal program many people miss: Extra Help, also called the Low-Income Subsidy (LIS). It's run through Medicare and Social Security, and it can significantly reduce what you pay for Part D drug coverage.

Here's what Sterling Heights readers should know heading into 2027, and how to apply if you think you might qualify.

What Extra Help actually does

Extra Help lowers the cost of Medicare prescription drug coverage (Part D). People who qualify pay no Part D premium for a "benchmark" plan, no yearly deductible, and only small, capped copays for covered drugs. In 2024, Congress fully expanded the program so there is now one level of Extra Help — you either qualify for the full benefit or you don't.

This matters even more now, because Part D itself has changed. The out-of-pocket cap on covered prescriptions is $2,100 in 2026 and $2,400 in 2027, the maximum Part D deductible is $615 in 2026 and $700 in 2027, and the old "donut hole" coverage gap is gone (Part D now has just three phases). For people with Extra Help, those numbers get much smaller still.

Who qualifies in 2027

You may qualify for Extra Help if you have Medicare and your income and resources fall under federal limits. As a rough guide, Social Security says most people qualify if their annual income is under about $23,000 for a single person or $31,000 for a married couple living together, with resources under roughly $17,600 (single) or $35,130 (married). Resources include things like money in a checking or savings account and stocks — but not your home, one car, or personal belongings.

Some people are automatically enrolled and don't have to apply at all. You're auto-enrolled if you have:

• Full Medicaid coverage,
• A Medicare Savings Program through your state, or
• Supplemental Security Income (SSI).

If that's you, you should get a purple or yellow letter from Medicare confirming it.

Why Sterling Heights residents should pay attention

Sterling Heights is in Macomb County, where Medicare beneficiaries have a broad menu of stand-alone Part D plans and Medicare Advantage plans that include drug coverage. Plan availability is set at the county level, not the city level, so two neighbors on the same street in Sterling Heights see the same list of options.

Extra Help works with any Part D plan, but the subsidy fully covers the premium only for plans designated as "benchmark" in Michigan. If you qualify for Extra Help and pick a non-benchmark plan, you may still owe a small portion of the premium. A Michigan SHIP counselor (details below) can walk through this with you at no cost.

How to apply

There are three easy ways to apply for Extra Help — and applying is free:

1. Online at ssa.gov/extrahelp. 2. By phone at Social Security, 1-800-772-1213 (TTY 1-800-325-0778). 3. In person at your local Social Security office.

You can apply at any time of year — there's no enrollment window for Extra Help itself. If you're approved, Social Security will send a letter, and you'll then choose (or be assigned to) a Part D plan.

If you already have a Part D plan and later qualify for Extra Help, you get a Special Enrollment Period to switch plans, so you're not stuck waiting for fall.

Other tools that stack with Extra Help

Even people who don't qualify for Extra Help have options in 2027:

• The Part D out-of-pocket cap ($2,100 in 2026 and $2,400 in 2027) applies to everyone with Part D. Once you hit it, you pay nothing more for covered drugs the rest of the year.
• The Medicare Prescription Payment Plan lets you spread your drug costs into predictable monthly payments across the year instead of paying a big bill at the pharmacy counter. It's optional and free to join — ask your Part D plan.
• Medicare Savings Programs through the Michigan Department of Health and Human Services can help pay Part B premiums and, in many cases, automatically trigger Extra Help.

For higher earners, keep in mind IRMAA — the income-related surcharge — kicks in above $109,000 in income for a single filer in 2026. That's a separate rule from Extra Help.

Key dates to remember

• October 15 – December 7: Medicare Annual Enrollment Period. Change or join a Part D or Medicare Advantage plan.
• January 1 – March 31: Medicare Advantage Open Enrollment. If you're in Medicare Advantage, you get one chance to switch.
• Any time: Apply for Extra Help. If approved, you'll get a Special Enrollment Period to change drug plans.