Medicare Part D
Medina Medicare Part D help through the Extra Help program
MEDINA, Ohio — If prescription costs are stretching your budget, there's a federal program that could ease the squeeze — and a lot of people who qualify don't know it exists. It's called Extra Help, sometimes known as the Low-Income Subsidy (LIS), and it helps people with limited income and savings pay for their Medicare Part D drug coverage.
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Speak to a Licensed Insurance Agent
Click to call 855-729-3240Key takeaways
- Extra Help (also called the Low-Income Subsidy) is a federal program run by Social Security and Medicare that can pay for or reduce Part D drug plan costs for people with limited income and savings.
- The Part D out-of-pocket cap is $2,100 in 2026 and $2,400 in 2027, and the maximum Part D deductible is $615 in 2026 and $700 in 2027. Since 2025 the "donut hole" gap is gone, leaving just three coverage phases.
- As of 2024, the program was expanded so anyone who meets the income test gets the full subsidy, since the old partial tier was eliminated, meaning more people may now qualify.
- People with Extra Help can also use a Special Enrollment Period to switch drug plans once per quarter during the first three quarters of the year, and they can still use the separate Medicare Prescription Payment Plan to spread drug costs into monthly payments.
A Program Many Ohioans Miss
Medina is in Medina County, where residents have several stand-alone Part D drug plans and Medicare Advantage drug plans to choose from during Medicare's enrollment windows. But no matter which plan you pick, Extra Help can lower what you pay at the pharmacy — often by a lot.
Here's a plain-English guide to how it works, who qualifies, and the mistakes to avoid when you apply.
What Extra Help Actually Does
Extra Help is run by the Social Security Administration and Medicare. If you qualify, it can pay for or reduce:
- Your Part D monthly premium (up to a set benchmark amount)
- Your Part D deductible
- Your copays for covered prescription drugs
For 2026, Medicare has also capped what any Part D enrollee pays out of pocket for covered drugs at $2,100 a year, and the maximum Part D deductible is $615. The old "donut hole" coverage gap was eliminated in 2025, so Part D now has just three phases: deductible, initial coverage, and catastrophic. Extra Help sits on top of all of that, pushing costs down further for those who qualify.
If you get the full subsidy, your copays for covered drugs drop to just a few dollars each. Even the partial subsidy can make a meaningful difference.
Who Qualifies for 2027
Extra Help is based on income and resources (savings and certain assets — not counting your home or car). The federal limits change slightly each year, so always check the current figures at Medicare.gov or SSA.gov.
You're automatically enrolled in Extra Help if you:
- Have both Medicare and full Medicaid
- Get help from your state Medicaid program paying your Medicare premiums (an MSP)
- Receive Supplemental Security Income (SSI)
If none of those apply, you can still qualify — you just have to apply. As of 2024, the program was expanded so that anyone who meets the income test now gets the full subsidy; the old partial tier was eliminated. That means more Medina-area residents may qualify than in past years.
The Mistakes That Cost People Money
This is where a lot of good coverage goes to waste. Watch out for these:
1. Assuming you make "too much." Many people never apply because they think they won't qualify. The limits are higher than most folks assume, and your home, one car, and personal belongings don't count as resources. Apply and let Social Security decide.
2. Not reapplying after a life change. If your income drops — say, after retirement, a spouse's death, or a job loss — you may now qualify even if you didn't before.
3. Confusing Extra Help with Medicaid or MSP. These are separate programs, though they overlap. You can qualify for one and not the others. It's worth checking all three.
4. Getting Extra Help but staying in a plan that doesn't fit. Extra Help travels with you, but your drugs, pharmacies, and plan formulary still matter. Review your plan each fall during Annual Enrollment (Oct. 15 – Dec. 7).
5. Forgetting about the Medicare Prescription Payment Plan. This new option lets you spread your drug costs across the year in monthly payments instead of paying big amounts up front. It's separate from Extra Help but can be used together.
How to Apply
There's no fee to apply, and you don't need anyone to file for you. You can:
- Apply online at ssa.gov/extrahelp
- Call Social Security at 1-800-772-1213
- Visit your local Social Security office
- Get free help from Ohio's SHIP (State Health Insurance Assistance Program), called OSHIIP in Ohio, at 1-800-686-1578
Have your Social Security number, bank statements, and information about any investments handy. The application takes most people less than half an hour.
When Extra Help Kicks In
Once approved, Extra Help usually starts the month you apply or the following month. If you're not already in a Part D plan, Medicare will enroll you in one — but you can switch to a different plan that better fits your prescriptions. People with Extra Help also get a Special Enrollment Period that lets them change drug plans once per quarter during the first three quarters of the year, outside the normal Oct. 15 – Dec. 7 window.
By the numbers
Medicare Part B premium, 2006–2026
The standard monthly Part B premium has climbed from $88.50 in 2006 to $202.90 in 2026. Hover any point for that year’s premium.
Source: CMS. Standard premium shown; in some hold-harmless years many existing enrollees paid less. Confirm at Medicare.gov.
By the numbers
How people get Medicare in Medina County
(MA penetration in Medina County)
MA penetration from CMS enrollment data; Medigap share is an estimate. U.S. average is about 54% Medicare Advantage. These are area-level figures, not plan-specific.
Try it
Find your 2026 Medicare premium
Most people pay the standard Part B premium. If your 2024 income was higher, an income-related surcharge (IRMAA) applies. Enter your details to see your bracket.
Surcharges are added to your premiums and based on your 2024 tax return. Married-filing-separately uses a different schedule. Confirm at Medicare.gov.
Try it
How the 2026 Part D drug cap works
Slide to your estimated yearly prescription costs and see how the new $2,100 out-of-pocket cap protects you. This illustrates the standard Part D benefit; your plan may structure costs differently.
Once your out-of-pocket spending on covered drugs reaches $2,100, you pay nothing more for the rest of 2026. Confirm details at Medicare.gov.
Good to know
Frequently asked questions
Q: I have a house and a car. Does that disqualify me?
Q: I was denied Extra Help a few years ago. Should I try again?
Q: Does Extra Help pay for my Medicare Advantage plan?
- CMS — Medicare Part D program rules (medicare.gov)
For personalized answers, contact Medicare.gov, 1-800-MEDICARE, or your local SHIP.