Medicare Part D

What Extra Help means for Cookeville Medicare Part D enrollees

COOKEVILLE, Tenn. — If prescription costs have been squeezing your budget, there's a federal program that could quietly change your monthly math. It's called Extra Help, also known as the Low-Income Subsidy (LIS), and it helps people with limited income and resources pay for their Medicare Part D prescription drug coverage.

Many people who qualify never apply — sometimes because they assume they earn too much, sometimes because no one told them the rules changed. Here's what to know before you rule yourself out.

What Extra Help actually does

Extra Help is a federal benefit run by the Social Security Administration and Medicare. If you qualify, it can:

• Lower or eliminate your Part D monthly premium (up to the benchmark amount in your area).
• Wipe out the Part D deductible.
• Cap what you pay at the pharmacy counter for covered generic and brand-name drugs at small, fixed amounts set by Medicare each year.
• Remove any late enrollment penalty you may have built up for Part D.

As of 2024, Medicare simplified the program. The old "partial" Extra Help tier was folded into full Extra Help, so people who qualify now get the full benefit. That's a meaningful change — some folks who were told "you only get a little help" a few years ago may now get much more.

Who qualifies in 2026

Two things are looked at: your income and your resources (things like money in the bank, stocks, and bonds — your home, car, and personal belongings don't count).

The exact income and resource limits are updated each year by Medicare and Social Security. As a general guide, Extra Help is aimed at people with income at or below 150% of the federal poverty level, with modest resources. Don't guess — even if you think you're just over, apply anyway. Certain income and household situations can put you under the limit when the math is done officially.

You automatically qualify for Extra Help (no application needed) if you have Medicare and:

• You get full Medicaid benefits (in Tennessee, that's TennCare), or
• You get Supplemental Security Income (SSI), or
• Your state pays your Medicare Part B premium through a Medicare Savings Program.

If any of those apply to you, Medicare will mail you a letter confirming your Extra Help status.

Common mistakes to avoid

Assuming you make too much. The income limit is higher than many people expect, and certain expenses can be subtracted. Apply and let Social Security decide.

Confusing Extra Help with Medicaid. They're separate programs. You can get Extra Help without qualifying for TennCare.

Waiting for fall. You can apply for Extra Help any time — it isn't tied to the Annual Enrollment Period (Oct. 15–Dec. 7). Once approved, you can also switch or join a Part D plan outside the normal windows.

Forgetting to reapply after a life change. If your income drops — say, after retirement or the loss of a spouse — you may newly qualify. Reapply.

Ignoring the letter from Medicare. Each fall, Medicare sends notices about changes to your Extra Help status or your Part D plan. Open them.

How to apply

You have a few free options:

• Online: Apply through the Social Security Administration at ssa.gov/extrahelp.
• By phone: Call Social Security at 1-800-772-1213 (TTY 1-800-325-0778).
• In person: Visit your local Social Security office.
• With free help: Tennessee's State Health Insurance Assistance Program (SHIP) offers unbiased, one-on-one counseling. SHIP counselors can walk you through the application and check whether you also qualify for a Medicare Savings Program.

There's no cost to apply, and applying does not affect your other benefits.

How this fits with the rest of Part D in 2026

Even if you don't qualify for Extra Help, the Part D program itself has changed in ways that help everyone:

• The out-of-pocket cap is $2,100 in 2026. Once you hit that in covered drug costs, you pay $0 for covered drugs the rest of the year.
• The Part D deductible cannot exceed $615 in 2026.
• The old coverage gap ("donut hole") is gone as of 2025 — Part D now has three phases instead of four.
• The Medicare Prescription Payment Plan lets you spread your drug costs across the year in monthly installments instead of paying big amounts at the pharmacy. It's optional and free to join.

Higher-income beneficiaries (above $109,000 for a single filer in 2026) pay an IRMAA surcharge on Part D — that's the opposite end of the income scale from Extra Help, but it's worth knowing the program treats income at both ends.

What Cookeville-area readers should know

Cookeville is in Putnam County, where multiple stand-alone Part D plans and Medicare Advantage plans with drug coverage are offered. Availability and plan details are set at the county level by Medicare each year. To compare what's offered in Putnam County — and to see which plans work with Extra Help — use the Plan Finder at medicare.gov or call 1-800-MEDICARE.

If you'd rather sit down with someone, Tennessee SHIP counselors serve the Upper Cumberland region and can meet with you at no charge.