Medicare Part D

Medicare Part D Extra Help: Johnstown Eligibility Rules

JOHNSTOWN, Pa. — For older adults in Johnstown living on tight budgets, prescription drug costs can be one of the hardest parts of Medicare to manage. A federal program called Extra Help — also known as the Low-Income Subsidy (LIS) — is designed to bring those costs down, and more people qualify than you might think.

With the Annual Enrollment Period running now through December 7, this is a good time to check whether you or a loved one could get help paying for Medicare Part D.

What Extra Help Actually Does

Extra Help is a federal program run by the Social Security Administration and Medicare. It lowers what people with limited income and resources pay for their Part D prescription drug coverage. According to CMS — Medicare Part D program rules (medicare.gov), people who qualify can see reductions in:

• Their Part D monthly premium
• Their annual deductible (which is capped at $615 for anyone in 2026 and $700 in 2027, and lower or $0 for those with Extra Help)
• Their copays at the pharmacy

As of 2024, the program was expanded so that everyone who qualifies now gets the full subsidy — there is no longer a partial tier. That change alone opened the door for many more people.

Who Qualifies in 2027

You may qualify for Extra Help if your income and resources fall below the federal limits set each year. As a general guide from Medicare:

• Income must be below 150% of the federal poverty level. For 2025, that was roughly $23,475 for one person and $31,725 for a married couple living together. The 2026 and 2027 figures update slightly each year.
• Resources — things like money in checking, savings, stocks, and bonds — must be below about $17,600 for one person or $35,130 for a married couple (2025 limits; adjusted annually). Your home, one car, and personal belongings don't count.

If you already have Medicaid, a Medicare Savings Program, or Supplemental Security Income (SSI), you automatically qualify for Extra Help — you don't need to apply separately.

How Extra Help Fits with 2027 Part D Changes

Even without Extra Help, Part D looks different in 2027 than it did just a few years ago:

• The coverage gap (the old "donut hole") was eliminated in 2025. There are now just three payment phases.
• There is an out-of-pocket cap on covered Part D drugs — $2,100 in 2026 and $2,400 in 2027. Once you hit it, you pay nothing more that year for covered prescriptions.
• The Medicare Prescription Payment Plan lets anyone in Part D spread their drug costs into monthly payments instead of paying large amounts at the pharmacy counter.

Extra Help stacks on top of these protections. For people who qualify, out-of-pocket costs are typically far lower than the annual cap.

What This Looks Like in Johnstown

Johnstown is in Cambria County, where Medicare beneficiaries choose between Original Medicare (with an optional stand-alone Part D plan) and Medicare Advantage plans that include drug coverage. The number of Part D and Advantage options available in Cambria County changes each year, and the plan-availability data is set at the county level — not by ZIP code or city.

Extra Help works with any Medicare drug plan you enroll in. It is not tied to one carrier or one specific plan.

How to Apply

There is no cost to apply, and applying does not commit you to anything. You can:

1. Apply online at ssa.gov/extrahelp 2. Call Social Security at 1-800-772-1213 3. Call 1-800-MEDICARE (1-800-633-4227) for guidance 4. Contact Pennsylvania's SHIP — the State Health Insurance Assistance Program, called APPRISE in Pennsylvania — for free, one-on-one counseling. In the Johnstown area, APPRISE counselors can walk through your situation without trying to sell you anything.