Medicare Part D
Why many Auburn Medicare enrollees miss Extra Help
AUBURN, Wash. — For many people on Medicare, the hardest part of the month isn't the doctor visit — it's the pharmacy counter. If prescription costs are stretching your budget thin, there's a federal program worth knowing about: Extra Help, also called the Low-Income Subsidy (LIS). It's designed to lower what you pay for Medicare Part D prescription drugs, and thousands of people who qualify never sign up because they assume they won't.
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Key takeaways
- Extra Help, also called the Low-Income Subsidy, is a federal program that can lower or eliminate your Part D premium and deductible and cap drug copays at small set amounts.
- Since 2024, the partial benefit tier is gone, so everyone who qualifies now gets the full level of assistance.
- If you already have Medicaid, SSI, or a Medicare Savings Program, you automatically qualify and don't need a separate application, and you can apply for Extra Help any time of year, not just during the Oct. 15–Dec. 7 Annual Enrollment Period.
- Free, unbiased help with Extra Help applications is available through SHIBA (Washington's SHIP), Medicare.gov, or 1-800-MEDICARE.
Here's a plain-language look at what Extra Help does, who qualifies, and the mistakes that can keep eligible neighbors from getting it.
What Extra Help actually does
Extra Help is a federal program run by the Social Security Administration and Medicare. If you qualify, it can lower or eliminate your Part D plan premium and deductible, and cap what you pay for covered generic and brand-name drugs at very small copay amounts set by Medicare each year.
As of 2024, Congress expanded Extra Help so that everyone who qualifies gets the full benefit — the old "partial" tier is gone. That's a meaningful change, because it means more people now receive the strongest level of assistance.
Extra Help works alongside two other important Part D rules that apply to everyone:
- A $2,100 annual out-of-pocket cap on covered Part D drugs.
- A $615 maximum Part D deductible (many plans set theirs lower).
- The old "donut hole" coverage gap was eliminated in 2025, so Part D now has three phases instead of four.
Who qualifies
Eligibility is based on income and resources. General federal guidelines (figures adjust slightly each year) are:
- Income at or below roughly 150% of the federal poverty level — about $23,475 a year for a single person and $31,725 for a married couple living together. Some income doesn't count, so don't rule yourself out based on a paycheck alone.
- Resources at or below about $17,600 for an individual and $35,130 for a couple. Resources include things like money in checking, savings, stocks, and bonds. Your home, one car, burial plots, and household items do not count.
If you already have Medicaid, Supplemental Security Income (SSI), or a Medicare Savings Program, you automatically qualify for Extra Help — you don't need to apply separately.
Auburn is in King County, Washington, where residents can choose from 49 Medicare Advantage plans offered by 11 carriers for 2027, along with stand-alone Part D options. Extra Help can be used with a plan you pick yourself.
Common mistakes to avoid
This is where a lot of eligible people miss out. Watch for these:
1. Assuming you make too much. The income limits are higher than most people expect, and not every dollar counts. Apply and let Social Security do the math. 2. Confusing Extra Help with Medicaid. They're different programs with different rules. You can get Extra Help even if you don't qualify for Medicaid. 3. Not reapplying after a life change. Losing a spouse, retiring, or a drop in income can newly qualify you. You can apply any time of year. 4. Skipping Part D because drugs feel cheap now. If you don't enroll in a Part D plan when first eligible and don't have other creditable drug coverage, you can face a late enrollment penalty that follows you for life. Extra Help can eliminate that penalty for those who qualify. 5. Waiting for the Annual Enrollment Period to act. Extra Help applications aren't tied to AEP (Oct. 15–Dec. 7). You can apply today.
How to apply
Applying is free. You can do it three ways:
- Online at ssa.gov/extrahelp
- By calling Social Security at 1-800-772-1213
- In person at a local Social Security office
You'll be asked about income, savings, and household size. If you're approved, Medicare will help you choose or switch to a Part D plan that works with the subsidy — and people with Extra Help get special enrollment periods to change plans outside the usual windows.
Where to get free, unbiased help in Auburn
You don't have to figure this out alone, and you shouldn't rely on a sales call to walk you through it. In Washington, the Statewide Health Insurance Benefits Advisors (SHIBA) program is the local SHIP (State Health Insurance Assistance Program). SHIBA counselors are trained volunteers who give free, one-on-one help with Medicare questions — including Extra Help applications.
You can reach SHIBA at 1-800-562-6900 or find a local counselor through the Washington State Office of the Insurance Commissioner.
By the numbers
Medicare Part B premium, 2006–2026
The standard monthly Part B premium has climbed from $88.50 in 2006 to $202.90 in 2026. Hover any point for that year’s premium.
Source: CMS. Standard premium shown; in some hold-harmless years many existing enrollees paid less. Confirm at Medicare.gov.
By the numbers
How people get Medicare in King County
(MA penetration in King County)
MA penetration from CMS enrollment data; Medigap share is an estimate. U.S. average is about 54% Medicare Advantage. These are area-level figures, not plan-specific.
Try it
Find your 2026 Medicare premium
Most people pay the standard Part B premium. If your 2024 income was higher, an income-related surcharge (IRMAA) applies. Enter your details to see your bracket.
Surcharges are added to your premiums and based on your 2024 tax return. Married-filing-separately uses a different schedule. Confirm at Medicare.gov.
Try it
How the 2026 Part D drug cap works
Slide to your estimated yearly prescription costs and see how the new $2,100 out-of-pocket cap protects you. This illustrates the standard Part D benefit; your plan may structure costs differently.
Once your out-of-pocket spending on covered drugs reaches $2,100, you pay nothing more for the rest of 2026. Confirm details at Medicare.gov.
Good to know
Frequently asked questions
Q: I own my home. Does that disqualify me from Extra Help?
Q: My spouse works but I don't. Can I still qualify?
Q: If I get Extra Help mid-year, do I have to wait until fall to change my drug plan?
- CMS — Medicare Part D program rules (medicare.gov)
For personalized answers, contact Medicare.gov, 1-800-MEDICARE, or your local SHIP.