Medicare Part D

Extra Help With Medicare Drug Costs: Do You Qualify?

NEWBERG, Ore. — If you're on Medicare and prescription costs are stretching your budget, there's a federal program that could quietly do a lot of heavy lifting: Extra Help, also called the Low-Income Subsidy (LIS). It lowers what you pay for Part D drug coverage — and thanks to recent changes, more people qualify than most folks realize.

Here's a plain-language look at who's eligible, what Extra Help actually does, and how to apply.

What Extra Help Is

Extra Help is a federal program run by Social Security and Medicare. It helps people with limited income and resources pay for their Medicare Part D prescription drug plan. That can include help with the plan's monthly premium, the annual deductible, and the copays you pay at the pharmacy.

As of 2024, Extra Help was expanded so that everyone who qualifies now gets the full benefit. The old "partial" Extra Help tier is gone. That's a meaningful change if you looked into this a few years ago and were told you only qualified for partial help.

Who Qualifies in 2026

To qualify for Extra Help, you must have Medicare and meet income and resource limits set by Social Security. The exact numbers are updated each year, but as a general guide:

• Income: Up to 150% of the federal poverty level. For a single person, that's roughly around $23,000 a year; for a married couple living together, roughly $31,000. Some income doesn't count, so don't rule yourself out based on a rough estimate.
• Resources: Things like money in checking, savings, stocks, and bonds. The limits are roughly $17,000 for an individual and about $34,000 for a married couple. Your home, one car, and personal belongings do not count.

You may automatically qualify — without applying — if you have Medicare and also have:

• Full Medicaid,
• A Medicare Savings Program (which helps pay Part B costs), or
• Supplemental Security Income (SSI).

If that's you, Medicare will send a letter letting you know.

What Extra Help Actually Pays For

For people who qualify in 2026, Extra Help can:

• Pay your Part D plan's monthly premium (up to a benchmark amount),
• Eliminate the Part D deductible (which can be up to $615 in 2026 for people without Extra Help),
• Cap what you pay at the pharmacy at small, set copay amounts for covered drugs.

This works alongside another big 2026 change: everyone on Part D now has a $2,100 annual out-of-pocket cap on covered prescription drugs, and the old "donut hole" coverage gap was eliminated in 2025. Part D now has three simpler phases. Extra Help sits on top of those protections and lowers costs even further for those who qualify.

There's also the Medicare Prescription Payment Plan, a separate option that lets any Part D enrollee spread drug costs out in monthly payments across the year instead of paying a big bill all at once. It doesn't lower your total costs, but it can smooth them out.

How to Apply

You can apply for Extra Help at any time — you don't have to wait for a Medicare enrollment window. Three ways to do it:

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

The application is free. Nobody should charge you to fill it out.

Once Social Security approves you, you'll still need to be enrolled in a Part D prescription drug plan for the help to kick in. If you don't pick one, Medicare may enroll you in one automatically so you don't go without coverage.

A Note on Local Help in Newberg

Newberg is in Yamhill County, where — like the rest of Oregon — Medicare beneficiaries have a range of stand-alone Part D drug plans and Medicare Advantage plans that include drug coverage. Availability and plan details are set at the county level and change each year during the Annual Enrollment Period (Oct. 15 – Dec. 7).

For free, unbiased, one-on-one help sorting through your options, Oregon's SHIBA program (Senior Health Insurance Benefits Assistance) is the state's SHIP. Counselors are trained volunteers, not salespeople, and the service is free. Call 1-800-722-4134 to find a local counselor.