Medicare Part D

Mount Laurel readers ask: do I qualify for Extra Help with my Part D drug costs?

MOUNT LAUREL, N.J. — If prescription costs are stretching your budget, a federal program called Extra Help — also known as the Low-Income Subsidy, or LIS — can pay for much of what Medicare Part D would otherwise cost you. And in 2027, more people may find the math works in their favor, thanks to a $2,400 yearly cap on what any Part D enrollee pays out of pocket for covered drugs.

Medicare Part DMount Laurel, NJ

Extra Help is separate from your Part D plan itself. You apply once through Social Security or your state, and if you qualify, the savings follow you into whichever Part D plan you choose. Here is how it works and who is eligible, according to CMS — Medicare Part D program rules (medicare.gov).

What Extra Help actually pays for

Extra Help is a federal subsidy that reduces what you pay for a Medicare Part D prescription drug plan. For people who qualify, it can wipe out the Part D premium (up to a benchmark amount set for your region), eliminate the deductible and cut most drug copays down to a few dollars per prescription.

It does not pay for over-the-counter medicine, and it does not cover drugs your Part D plan does not include on its formulary. It also does not replace your Part D plan — you still need to be enrolled in one.

Who qualifies in 2027

Eligibility is based on two things: your income and your "resources" (savings, investments and certain other assets — not your home or car).

As a general guide, single filers with income at or below roughly 150% of the federal poverty level, and with resources under the annual limit set by Social Security, may qualify. Limits are higher for married couples living together. The exact thresholds update each year, so check the current numbers at ssa.gov/extrahelp or medicare.gov before you rule yourself out.

A key change worth knowing: as of 2024, Congress ended the old "partial" Extra Help tier. Anyone who qualifies now receives the full subsidy. If you were told years ago that you only qualified for partial help, it is worth reapplying.

You are automatically enrolled in Extra Help if you have Medicare and also have Medicaid, Supplemental Security Income (SSI), or a Medicare Savings Program through New Jersey.

How Extra Help fits with the 2027 Part D changes

Even without Extra Help, Part D looks different now than it did a few years ago. There is no more coverage gap ("donut hole") — the benefit has just three phases. The maximum deductible any plan can charge is $700 in 2027, and once your out-of-pocket spending on covered drugs reaches $2,400, you pay nothing more for the rest of the year.

Extra Help sits on top of those protections. For someone who qualifies, the deductible is usually zero and copays are capped at small fixed amounts set by CMS. There is also an option called the Medicare Prescription Payment Plan that lets any Part D enrollee spread out-of-pocket drug costs across the calendar year in monthly installments — useful if a big prescription bill hits in January.

How to apply from Mount Laurel

Mount Laurel is in Burlington County, where residents have several ways to apply:

• Online at ssa.gov/extrahelp
• By phone at 1-800-772-1213 (Social Security)
• In person at a local Social Security office
• Through New Jersey's SHIP program (State Health Insurance Assistance Program), which offers free one-on-one counseling

You do not need to wait for the Annual Enrollment Period (Oct. 15 – Dec. 7) to apply for Extra Help. Applications are accepted year-round, and approval opens a Special Enrollment Period so you can switch Part D plans if the one you have is no longer the best fit.

What to have ready

Before you apply, gather:

• Your Social Security number and Medicare card
• Recent bank statements and any investment or retirement account balances
• Pay stubs, tax returns or other proof of income
• A list of your current prescriptions (helpful when comparing plans afterward)

If your income is close to the limit, apply anyway. Social Security will do the math, and the resource rules exclude several things people often forget about — your primary home, one vehicle, burial funds up to a set amount, and household goods.