Medicare Part D

Extra Help With Medicare Drug Costs: Do You Qualify?

NEW BRAUNFELS, Texas — If prescription costs are stretching your budget, there's a federal program that could quietly do a lot of the heavy lifting. It's called Extra Help, and it's designed for people with Medicare who have limited income and savings. Many people who qualify don't realize it — or assume the paperwork isn't worth the trouble. In most cases, it is.

Here's a plain-language look at how Extra Help works heading into 2027, who qualifies, and how to apply from right here in Comal County.

What Extra Help actually does

Extra Help — sometimes called the Low-Income Subsidy (LIS) — is a federal program run by Social Security and Medicare. It helps pay for the costs tied to Medicare Part D, the part of Medicare that covers prescription drugs.

If you qualify, Extra Help can lower or eliminate:

• Your Part D monthly premium (up to a benchmark amount)
• Your Part D deductible
• What you pay at the pharmacy counter for covered drugs

It also gives you a Special Enrollment Period, meaning you can change your Part D or Medicare Advantage drug plan once per quarter during the first three quarters of the year — you don't have to wait for the fall Annual Enrollment Period.

For context, in 2026 the standard Part D deductible can be as high as $615, and out-of-pocket drug costs are capped at $2,100 for the year. Extra Help sits underneath those numbers and pulls them down further for people who qualify.

Who qualifies for 2027

Two things determine eligibility: your income and your resources (savings and certain assets). The limits are set nationally by the Social Security Administration and adjust each year.

As a general guide, you may qualify for full Extra Help if your income is at or below roughly 150% of the federal poverty level, and your resources are under program limits. Your home, one car, burial plots, and personal belongings don't count as resources.

You automatically get Extra Help — no application needed — if you already have:

• Medicaid (in Texas, that includes people on full Medicaid)
• A Medicare Savings Program through your state
• Supplemental Security Income (SSI)

If that's you, Medicare will send a purple or yellow letter confirming it. Keep it.

Why this matters heading into 2027

A big change took effect in 2025: the coverage gap — the old "donut hole" — is gone. Part D now has just three phases (deductible, initial coverage, catastrophic). That's simpler, but drug list prices and plan designs still vary a lot. The new $2,100 out-of-pocket cap is a real safety net, but $2,100 is still a stretch for many households on a fixed income. Extra Help is how the program tries to close that gap for people who need it most.

There's also the Medicare Prescription Payment Plan, a separate option that lets anyone with Part D spread their drug costs across monthly payments instead of paying big bills at the pharmacy. It doesn't lower your costs, but it can smooth them out. You can use it alongside Extra Help.

How to apply

You can apply for Extra Help any time of year — there's no deadline. It's free, and the application is short.

Three ways to apply:

1. Online at ssa.gov/extrahelp 2. By phone at Social Security, 1-800-772-1213 (TTY 1-800-325-0778) 3. In person at a local Social Security office

You'll be asked about income, savings, and household size. If you're married and living with your spouse, their information counts too.

Once Social Security decides you qualify, they'll notify Medicare, and your drug plan will apply the discount automatically. If you don't have a Part D plan yet, Medicare can enroll you in one so your Extra Help doesn't go to waste — though you're free to switch to a plan that better fits your prescriptions.

What's available around New Braunfels

New Braunfels is in Comal County, where Medicare plan availability is set at the county level. That means whether you're in downtown New Braunfels, Canyon Lake, or Bulverde, the same menu of stand-alone Part D plans and Medicare Advantage plans with drug coverage applies. When you compare plans on Medicare's Plan Finder, enter your ZIP code and your list of prescriptions — that's the only way to see how a specific plan would handle your drugs.

If you're approved for Extra Help, look for plans whose premiums fall at or below the LIS benchmark so the subsidy covers the full premium.

Key dates to remember

• Annual Enrollment Period: October 15 – December 7 (for coverage starting January 1)
• Medicare Advantage Open Enrollment: January 1 – March 31
• Extra Help application: any time, year-round
• Extra Help Special Enrollment Period: once per quarter, Jan–Sept, to change your drug plan

One more note: IRMAA — the income-related surcharge added to Part B and Part D premiums for higher earners — kicks in above $109,000 in income for a single filer in 2026. If IRMAA applies to you, Extra Help almost certainly does not, and vice versa. They're at opposite ends of the income spectrum.