Medicare Part D

Medicare Part D Premiums and Extra Help in Shoreline

If you live in Shoreline and take regular prescriptions, there's a federal program that can make a real difference — and many people who qualify never sign up for it. It's called Extra Help, sometimes known as the Low-Income Subsidy (LIS). It helps pay for Medicare Part D drug costs, including premiums, deductibles, and the amount you pay at the pharmacy counter.

A quieter way to lower prescription costs

Extra Help isn't a plan you shop for. It's a benefit you apply for through Social Security or your state Medicaid office, and it works alongside whatever Part D coverage you have.

What Extra Help actually does

Extra Help is designed to bring drug costs down for people with limited income and resources. According to CMS, people who qualify pay no more than a small, set amount for each covered prescription, and they don't pay a Part D deductible. Extra Help can also cover all or part of the monthly Part D premium, depending on the plan you're in.

It's also worth knowing the broader Part D rules that apply to everyone:

• The annual out-of-pocket cap for Part D is $2,100 in 2026.
• The Part D deductible is capped at $615.
• The old "donut hole" coverage gap was eliminated in 2025, so Part D now has three simpler phases.
• Anyone with Part D can also opt into the Medicare Prescription Payment Plan, which spreads your drug costs into monthly payments across the year.

Extra Help sits on top of all of that, further reducing what you pay.

Who qualifies in 2027

To qualify for full Extra Help in 2027, your income generally needs to be at or below 150% of the federal poverty level, and your resources (like money in checking, savings, stocks, or bonds) must fall under program limits set by Social Security. Your home, one car, and personal belongings don't count as resources.

A few things that trip people up:

• Income limits are higher in Alaska and Hawaii, but standard limits apply in Washington.
• If you're married and living with your spouse, both incomes are counted.
• If you already have Medicaid, Supplemental Security Income (SSI), or a Medicare Savings Program, you're automatically enrolled in Extra Help — no application needed.

Even if you were denied years ago, it's worth trying again. Congress expanded full Extra Help in 2024, so more people qualify now than before.

How Extra Help fits with Shoreline plan choices

Shoreline is in King County, where Medicare beneficiaries have a wide range of stand-alone Part D drug plans and Medicare Advantage plans with drug coverage to choose from. Extra Help works with either option. If you qualify, you can still switch plans — Extra Help recipients get a Special Enrollment Period that lets them change Part D coverage once per quarter during the first three quarters of the year, on top of the regular Annual Enrollment Period (Oct. 15 – Dec. 7).

That flexibility matters. If your medications change or a plan drops a drug from its formulary, you're not stuck waiting until fall to fix it.

How to apply

There are three easy paths:

1. Online at ssa.gov/extrahelp. 2. By phone at Social Security, 1-800-772-1213. 3. In person at a Social Security office, or with free help from Washington's SHIBA (Statewide Health Insurance Benefits Advisors) — the state's official SHIP counselors. Call 1-800-562-6900 to reach a local volunteer.

The application is short, and you don't need to send in bank statements or pay stubs to apply — Social Security verifies the information later.

What if you're just over the limit?

Even if your income is a little too high for Extra Help, Washington State has Medicare Savings Programs (MSPs) that can pay your Part B premium and sometimes more. Qualifying for an MSP also automatically enrolls you in Extra Help. It's worth checking both at the same time.