Medicare Part D

Extra Help & 2027 Medicare Drug Costs: La Vergne, TN

LA VERGNE, Tenn. — If prescription costs feel like they take a bigger bite each year, there's a federal program many people miss. It's called Extra Help, also known as the Low-Income Subsidy, or LIS. It helps people with Medicare pay for their Part D prescription drug coverage — including premiums, deductibles, and the cost of medications at the pharmacy.

A quieter way to lower prescription bills

Extra Help has been around for years, but a change that took full effect in 2024 made the program simpler and more generous. Today, if you qualify, you get the full benefit — there's no longer a partial version with reduced help. That's a meaningful shift for people who were on the edge of qualifying before.

What Extra Help actually does

Extra Help is tied to Part D, the part of Medicare that covers prescription drugs. According to CMS, people who qualify for the Low-Income Subsidy pay:

• No Part D premium (for benchmark plans) and no deductible.
• Sharply reduced copays for covered generic and brand-name drugs at the pharmacy.
• Nothing once they reach the Part D out-of-pocket cap, which is $2,100 in 2026 and $2,400 in 2027 for everyone with Part D.

Extra Help also removes the late enrollment penalty for Part D — so if you delayed drug coverage in the past, qualifying for LIS clears that penalty going forward.

It's worth pausing on that $2,100 in 2026 ($2,400 in 2027) number. Starting in 2025, Medicare eliminated the old "donut hole" and capped what any Part D enrollee pays out of pocket for covered drugs in a year. Extra Help layers on top of that, lowering costs long before you'd hit the cap.

Who qualifies for 2027

Eligibility is based on income and resources (savings and certain assets — not your home or car). The Social Security Administration sets the limits each year and adjusts them for inflation.

As a general guide, you may qualify for Extra Help if:

• Your income is at or below roughly 150% of the federal poverty level.
• Your resources fall under the annual limit set by SSA (higher limits apply if you're married and living with your spouse).
• You live in one of the 50 states or the District of Columbia.

You automatically get Extra Help — no application needed — if you have Medicare and also:

• Have full Medicaid coverage, or
• Get help from your state paying your Medicare premiums (a Medicare Savings Program), or
• Receive Supplemental Security Income (SSI).

If you're not automatic, you can apply anytime. There's no enrollment window for Extra Help itself.

How to apply

You can apply for Extra Help three ways, and all are free:

1. Online at ssa.gov/extrahelp. 2. By calling Social Security at 1-800-772-1213. 3. In person at your local Social Security office.

The application is short — about 10 minutes for most people. Social Security will ask about your income, savings, and household. You don't need to send in bank statements or tax forms to apply, though SSA may follow up for verification.

Tennesseans can also get free, one-on-one help from SHIP — the State Health Insurance Assistance Program. In Tennessee it's called TN SHIP, reachable at 1-877-801-0044. Counselors are trained and unbiased, and they don't sell insurance.

What Extra Help means locally

La Vergne is in Rutherford County, where Medicare beneficiaries have a range of stand-alone Part D drug plans and Medicare Advantage plans that include drug coverage. If you qualify for Extra Help, Medicare can enroll you in a benchmark Part D plan at no premium, or you can pick one yourself during the Annual Enrollment Period (Oct. 15 – Dec. 7) or the Medicare Advantage Open Enrollment Period (Jan. 1 – March 31).

People with Extra Help also get a Special Enrollment Period — meaning you can change your Part D plan once per quarter during the first three quarters of the year, without waiting for fall enrollment. That flexibility matters if your medications change or a plan drops a drug from its formulary.

Other tools that stack with Extra Help

Even if you don't qualify for LIS, two other rules can help your budget:

• The Part D out-of-pocket cap is $2,100 in 2026 and $2,400 in 2027. Once your covered drug spending hits that, you pay nothing for covered drugs the rest of the year.
• The Medicare Prescription Payment Plan lets you spread your drug costs across the calendar year in monthly installments instead of paying big amounts at the pharmacy counter. It's optional and free to join through your drug plan.

And the Part D maximum deductible is $615 in 2026 and $700 in 2027 — plans can charge less, but not more.