Medicare Part D

Low-Income Subsidy basics for Medicare Part D in Toledo

TOLEDO, Ohio — If prescription costs keep you up at night, there is a federal program that may quietly do more for your budget than any other single step you can take. It is called Extra Help, sometimes known as the Low-Income Subsidy, or LIS. And as 2027 approaches, with Medicare's drug coverage rules continuing to shift, it is worth a fresh look — even if you were told "no" in the past.

Here in Toledo, thousands of older adults and people with disabilities rely on Part D drug plans. Extra Help can lower what you pay for the plan itself and what you pay at the pharmacy counter. Here is what it is, who qualifies, and how to decide whether to apply.

What Extra Help Actually Does

Extra Help is a federal program run by the Social Security Administration and Medicare. It assists people with limited income and resources in paying for Medicare Part D — the part of Medicare that covers prescription drugs.

If you qualify, Extra Help can reduce or eliminate your Part D plan premium, lower or wipe out the Part D deductible (the standard maximum is $615 in 2026 and $700 in 2027), and cap what you pay for covered generic and brand-name drugs at the pharmacy. It also removes any late-enrollment penalty for Part D.

Extra Help works alongside your Part D plan. It is not a plan itself, and it does not replace your Medicare coverage.

Why 2027 Is a Good Year to Re-check

Medicare's drug benefit looks different than it did just a couple of years ago. As of 2025, the old "donut hole" coverage gap is gone, and Part D is now built around three simpler phases. The annual out-of-pocket cap on covered prescription drugs is $2,100 in 2026 and $2,400 in 2027. Once you reach that amount, you pay nothing more for covered drugs for the rest of the calendar year.

That cap helps everyone with Part D. But if you also qualify for Extra Help, your costs along the way to that cap can be dramatically lower.

There is also the Medicare Prescription Payment Plan, an optional program that lets you spread your yearly drug costs into monthly bills instead of paying big amounts at the pharmacy. Extra Help and the payment plan are separate programs, and you can look at both.

Who Qualifies for Extra Help

Eligibility is based on your income and your resources (savings, investments, and similar assets — not your house or car).

In general, you may qualify if:

• You have Medicare Part A, Part B, or both.
• Your income is at or below roughly 150% of the federal poverty level. For many single people, that has meant income under about $23,000 per year, and higher for married couples, but the exact figures update each year.
• Your countable resources are under the annual limit set by Social Security.

Some people qualify automatically and do not need to apply. This includes people who have both Medicare and full Medicaid, people enrolled in a Medicare Savings Program, and people who get Supplemental Security Income (SSI).

Because the income and resource limits change each year, do not rule yourself out based on an old answer. The 2024 changes expanded full Extra Help to more people, and many who were denied years ago now qualify.

How to Decide Whether to Apply

Ask yourself three simple questions:

1. Do prescription costs strain your monthly budget? If yes, Extra Help is worth exploring even if you are unsure about the limits. 2. Has your income or household changed? A retirement, the loss of a spouse, or a drop in work hours can move you into eligibility. 3. Are you already on Medicaid, SSI, or a Medicare Savings Program? If so, you may already be enrolled in Extra Help without knowing it — but confirm it.

There is no fee to apply, no penalty for applying and being denied, and you can reapply later if your situation changes.

How to Apply in the Toledo Area

Toledo is in Lucas County, and residents here have several no-cost ways to get help with the application:

• Online: Apply through the Social Security Administration at ssa.gov/extrahelp.
• By phone: Call Social Security at 1-800-772-1213, or Medicare at 1-800-MEDICARE (1-800-633-4227).
• In person: Ohio's State Health Insurance Assistance Program (SHIP), called OSHIIP, offers free, unbiased counseling. Local Area Agencies on Aging and senior centers in Lucas County can connect you with a counselor.

If you also want to compare Part D plan choices in Lucas County, you can do that at medicare.gov/plan-compare during the Annual Enrollment Period (October 15 – December 7) or, in some cases, using a Special Enrollment Period tied to Extra Help.