Medicare Part D

Low-Income Subsidy and Medicare Part D costs in Kirkland

KIRKLAND, Wash. — If paying for prescriptions feels tighter each year, there's a federal program many people miss: Extra Help, also called the Low-Income Subsidy (LIS). It's run through Medicare and Social Security, and it can lower or wipe out your Part D drug plan premium, deductible, and the amount you pay at the pharmacy counter.

What Extra Help is — and why it matters in 2027

Extra Help matters even more in 2026 because of two big Part D changes already on the books. Medicare has capped what anyone with a Part D plan pays out of pocket for covered drugs at $2,100 in 2026 ($2,400 in 2027) for the year, and the maximum Part D deductible is $615. Extra Help sits on top of those protections — for people who qualify, costs drop further still.

Who qualifies for Extra Help

Extra Help is based on your income and your resources (savings, investments, and similar assets). As of 2024, Medicare expanded the program so that everyone who qualifies gets the full subsidy — the old "partial" tier is gone.

In general, to qualify you must:

• Have Medicare Part A and/or Part B,
• Live in one of the 50 states or D.C., and
• Have income and resources under the federal limits, which are updated each year.

You automatically get Extra Help if you have Medicare and also:

• Have full Medicaid coverage (in Washington, that's Apple Health), or
• Get help from your state paying your Medicare premiums (a Medicare Savings Program), or
• Receive Supplemental Security Income (SSI).

If none of those apply, you can still qualify — you just have to apply. And many people who would qualify never do, often because they assume their income is "too high." It's worth checking.

What Extra Help actually pays for

For people who qualify, Extra Help can:

• Pay your Part D monthly premium (up to a benchmark amount set for your area),
• Eliminate the Part D deductible,
• Cap what you pay at the pharmacy for each covered prescription at a small set amount, and
• Get rid of any late-enrollment penalty you may have picked up for signing up for Part D late.

Extra Help works alongside a Part D drug plan — you still need to be enrolled in one. Kirkland is in King County, where Medicare beneficiaries have a wide selection of stand-alone Part D plans and Medicare Advantage plans that include drug coverage. If you qualify for Extra Help and don't pick a plan, Medicare will enroll you in one so your benefits start.

How to apply from Kirkland

There are three straightforward ways to apply:

1. Online at ssa.gov/extrahelp — the Social Security Administration handles applications. 2. By phone at 1-800-772-1213 (Social Security) or 1-800-MEDICARE (1-800-633-4227). 3. In person at a Social Security office. The closest offices to Kirkland are in Bellevue and Seattle; call ahead to confirm hours.

You'll be asked about income, savings, and household size. It's fine to estimate — Social Security will follow up if they need documents. There is no fee to apply, and you can apply at any time of year, not just during Medicare's fall enrollment window.

For free, unbiased help walking through the application, contact Washington's SHIBA program (Statewide Health Insurance Benefits Advisors) at 1-800-562-6900. SHIBA counselors don't sell anything — they're the state's official Medicare help line and work with people in Kirkland and across King County.

Other programs worth checking at the same time

While you're looking at Extra Help, ask about these too. People often qualify for more than one:

• Medicare Savings Programs (MSPs). Run by Washington State Health Care Authority, these help pay Part B premiums and sometimes deductibles and coinsurance. Qualifying for an MSP automatically qualifies you for Extra Help.
• Apple Health (Medicaid). For people with lower incomes, this can cover costs Medicare doesn't.
• The Medicare Prescription Payment Plan. New as of 2025, this lets anyone with a Part D plan spread drug costs across the calendar year in monthly installments instead of paying big amounts at the pharmacy. It doesn't lower your total — but it can smooth cash flow. You have to opt in through your plan.

Timing: when to apply and when coverage starts

You can apply for Extra Help any time of year. If you're approved, your Part D savings usually begin the month you apply or shortly after.

For choosing or changing your drug plan, keep these Medicare dates in mind:

• Annual Enrollment Period: Oct. 15 – Dec. 7 — anyone with Medicare can join, switch, or drop a Part D or Medicare Advantage plan.
• Medicare Advantage Open Enrollment: Jan. 1 – March 31 — if you're already in a Medicare Advantage plan, you get one chance to switch.
• Special Enrollment Period for Extra Help — once you qualify, you can change your Part D plan once per quarter during the first three quarters of the year, plus during AEP.