Medicare Part D

Extra Help in 2026: Who Qualifies and How to Apply

MISSOURI CITY, Texas — If prescription costs are stretching your budget, there's a federal program that could ease the pressure. It's called Extra Help, also known as the Low-Income Subsidy, and it helps people with Medicare pay for their Part D prescription drug coverage.

The rules changed in recent years to open the program to more people, and many who qualify still haven't signed up. Here's what Missouri City readers need to know before making a decision — and the common mistakes to avoid along the way.

What Extra Help actually does

Extra Help is a federal benefit that pays part of your Medicare prescription drug costs. If you qualify, it can lower or eliminate your Part D plan premium, reduce your deductible, and cap what you pay at the pharmacy counter for covered drugs.

Since 2024, the program has been simplified. There is no longer a "partial" Extra Help tier — everyone who qualifies now gets the full benefit. That's a meaningful change, because it means more people get more help than they would have a few years ago.

Extra Help works alongside a Part D plan or a Medicare Advantage plan that includes drug coverage. It does not replace those plans; it helps you pay for them.

Who qualifies in 2027

Eligibility is based on two things: your income and your resources (things like money in the bank or investments — your home and car don't count).

For 2025, you generally qualify if your yearly income is at or below 150% of the federal poverty level, and your resources are under the program limit. The Social Security Administration updates these numbers each year, so check ssa.gov for the current figures before you apply.

A few important notes:

• If you already have Medicaid, Supplemental Security Income (SSI), or a Medicare Savings Program, you automatically qualify. You do not need to apply.
• Even if you're a little over the limits, apply anyway. Certain income and expenses can be excluded, and Social Security makes the final call.
• Married couples living together are evaluated together, which affects the limits.

The mistakes people make

The biggest mistake is assuming you won't qualify. Many people never apply because they think their Social Security check is "too much" or their small savings will disqualify them. The limits are higher than most people expect, and the only way to know for sure is to apply.

Another common misstep is paying someone to file the application. The application is free. No one should charge you to fill it out. If someone contacts you offering to sign you up for a fee, that's a red flag.

People also sometimes forget that Extra Help is separate from choosing a drug plan. Qualifying for Extra Help doesn't automatically enroll you in Part D — you still need a plan to use the benefit. If you don't pick one, Medicare may assign you to one.

Finally, if your circumstances change — a spouse passes away, income drops, medical bills rise — reapply. Eligibility isn't a one-and-done question.

How Extra Help fits with 2027 Part D changes

Part D looks different than it did a few years ago. The old "donut hole" coverage gap was eliminated in 2025, so drug coverage now has three straightforward phases: deductible, initial coverage, and catastrophic.

Out-of-pocket spending on covered drugs is capped at $2,100 in 2026 and $2,400 in 2027 for everyone with Part D. The maximum allowable deductible is $615 in 2026 and $700 in 2027. If you have Extra Help, your costs will typically be well below those numbers.

There's also the Medicare Prescription Payment Plan, an optional program that lets you spread your drug costs across monthly payments instead of paying large amounts at the pharmacy. It doesn't lower total cost, but it can make budgeting easier. It's separate from Extra Help, and you can use both.

How to apply from Missouri City

You can apply for Extra Help three ways:

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

The application takes about 10 minutes. You'll be asked about income, savings, and living situation. Social Security will send a decision letter, usually within a few weeks.

Missouri City is in Fort Bend County, where residents have access to a range of Part D and Medicare Advantage plans with drug coverage. For free, unbiased local help — including help comparing plans after you're approved — contact Texas's State Health Insurance Assistance Program (called HICAP in Texas) or call 1-800-MEDICARE (1-800-633-4227).

Key dates to remember

Extra Help applications are accepted year-round. But your Part D plan choices happen during set windows:

• Annual Enrollment Period: October 15 – December 7
• Medicare Advantage Open Enrollment Period: January 1 – March 31

If you newly qualify for Extra Help, you also get a Special Enrollment Period to switch drug plans outside those windows.