Medicare Part D

Extra Help With Medicare Drug Costs: Upper Darby, PA

UPPER DARBY, Pa. — If you or someone you love takes prescriptions and lives on a modest income, there's a federal program that can make a real difference at the pharmacy counter. It's called Extra Help — also known as the Low-Income Subsidy (LIS) — and it lowers what people with Medicare pay for their Part D prescription drug coverage.

A quieter kind of Medicare help — and it's worth a look

Extra Help has been around for years, but a lot of people who qualify never apply. That's a missed opportunity, especially as Medicare's drug benefit continues to change. The Part D yearly out-of-pocket cap is $2,100 in 2026 and $2,400 in 2027. Extra Help layers on top of that, easing costs even further for people who meet the income and resource limits.

Here's a plain-language guide to who qualifies, what the program covers, and how to apply.

What Extra Help actually does

Extra Help is run by the Social Security Administration and the Centers for Medicare & Medicaid Services (CMS). If you qualify, it can:

• Pay all or part of your Part D monthly premium (up to a benchmark amount).
• Lower or eliminate your Part D deductible (the standard maximum is $615 in 2026 and $700 in 2027).
• Reduce what you pay for each prescription to a small, set amount.
• Remove the late enrollment penalty if you didn't sign up for Part D when you were first eligible.

In 2024, Congress expanded Extra Help so that everyone who qualifies now gets the full benefit — the older "partial" tier is gone. That's a meaningful change, because it means more people get the deepest level of help.

Who qualifies in 2027

To get Extra Help, you must have Medicare and meet limits on both income and resources (things like money in the bank and investments). The limits change slightly each year and are set a bit higher for married couples living together.

As a general guide, you may qualify if:

• Your income is at or below 150% of the federal poverty level, and
• Your resources fall under the annual limit set by Social Security (your home, one car, and personal belongings don't count).

You're automatically enrolled in Extra Help — no application needed — if you already have:

• Medicaid (full or partial),
• A Medicare Savings Program through your state, or
• Supplemental Security Income (SSI).

If you're not sure whether you're already enrolled, Social Security or your local State Health Insurance Assistance Program (SHIP) can check for you.

Why this matters in 2027

Medicare's drug benefit looks different now than it did just a couple of years ago. The old "donut hole" coverage gap was eliminated in 2025, leaving three simpler phases: deductible, initial coverage, and catastrophic. The out-of-pocket cap is $2,100 in 2026 and $2,400 in 2027 — meaning once your covered drug spending hits that amount, you pay nothing for covered drugs the rest of the year.

Medicare also offers the Medicare Prescription Payment Plan, which lets anyone with Part D spread their drug costs across monthly payments instead of paying large amounts at the pharmacy. It doesn't lower the total, but it can make budgeting easier. Extra Help works alongside these features — not instead of them.

How Upper Darby fits in

Upper Darby is in Delaware County, where Medicare beneficiaries choose between Original Medicare (with a stand-alone Part D plan) and Medicare Advantage plans that include drug coverage. Extra Help works with both. It travels with you regardless of which Part D plan you're enrolled in, as long as the plan is a Medicare-approved drug plan.

Delaware County residents can also get free, unbiased help from Pennsylvania's SHIP program, called APPRISE. Counselors there don't sell anything — they walk you through your options and help with paperwork.

How to apply

You can apply for Extra Help any time of year — you don't have to wait for a Medicare enrollment period. There are three simple ways:

1. Online: Go to 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 (call ahead for an appointment).

You'll be asked about household income, savings, and investments. Most people finish the application in under half an hour. Social Security will send a written decision, and if approved, coverage generally starts the month after you qualify.

Keep in mind that the Annual Enrollment Period (Oct. 15 – Dec. 7) and the Medicare Advantage Open Enrollment Period (Jan. 1 – March 31) are the windows for changing your Medicare plan itself. Extra Help enrollment isn't tied to those dates.

Reader questions

Q: I was denied Extra Help a few years ago. Should I try again? Yes. The rules changed in 2024 to expand full benefits to more people, and income and resource limits are updated each year. If your finances have shifted — or even if they haven't — it's worth reapplying.

Q: Will Extra Help affect my Social Security check or other benefits? No. Extra Help is a subsidy that pays your drug plan directly. It doesn't reduce your Social Security payment or count as taxable income.

Q: I have Medicaid. Do I need to apply? No. If you have full Medicaid, SSI, or a Medicare Savings Program, you're automatically enrolled in Extra Help. You'll get a purple or yellow notice from Medicare confirming it.

Q: Does Extra Help cover every drug? Extra Help lowers your costs for drugs your Part D plan covers. Each plan has its own formulary (drug list), so it's smart to check that your prescriptions are on it — medicare.gov's Plan Finder can show you.

Where to get trustworthy help

For personalized answers, start with these free, official resources:

• Medicare: medicare.gov or 1-800-MEDICARE (1-800-633-4227), 24/7.
• Social Security (for Extra Help applications): ssa.gov or 1-800-772-1213.
• APPRISE (Pennsylvania SHIP): free one-on-one Medicare counseling for Upper Darby and Delaware County residents. Find your local office at aging.pa.gov.

Extra Help isn't flashy, and it isn't automatic for everyone who qualifies. But for people who are eligible, it's one of the most useful pieces of the Medicare program — and applying costs nothing but a little time.