Medicare Part D

Federal Extra Help program for Medicare enrollees in Spokane Valley

SPOKANE VALLEY, Wash. — If prescription costs are stretching your budget, there's a federal program that could ease the pressure — and many people who qualify for it don't realize they do.

It's called Extra Help, sometimes known as the Low-Income Subsidy (LIS). Run by Social Security and Medicare, it helps people with limited income and savings pay for their Medicare Part D prescription drug coverage. With the Part D out-of-pocket cap set at $2,100 in 2026 and $2,400 in 2027, Extra Help can make an already stronger benefit even more affordable for those who need it most.

Here's what to know about who qualifies, what it covers, and how Spokane Valley residents can apply.

What Extra Help actually does

Extra Help lowers the cost of Medicare prescription drug coverage. For people who qualify, it can:

• Reduce or eliminate the Part D monthly plan premium (up to a benchmark amount).
• Wipe out the Part D deductible — which is capped at $615 for 2026 and $700 for 2027 for standard plans.
• Lower what you pay at the pharmacy counter for covered drugs to small, fixed amounts.
• Remove the Part D late enrollment penalty if you've gone without drug coverage.

In short, Extra Help works alongside your Part D plan (or the drug coverage inside a Medicare Advantage plan) to bring your costs down.

Who qualifies in 2026 and 2027

Extra Help is now a single full benefit — Congress expanded the program starting in 2024, so the old "partial" tier is gone. If you qualify, you get the full subsidy.

To be eligible, you generally need to:

• Have Medicare Part A and/or Part B,
• Live in one of the 50 states or D.C., and
• Fall within the income and resource limits set by Social Security.

As a general guide, Social Security says you may qualify if your annual income is below roughly 150% of the federal poverty level and your resources (savings, investments, and similar assets) fall under the program's limits — around $17,600 for an individual and $35,130 for a married couple living together in 2025, with figures updated annually. Your home, one vehicle, and personal belongings don't count toward resources.

Some people are automatically enrolled in Extra Help and don't have to apply, including those who:

• Have both Medicare and full Medicaid,
• Get help from a Medicare Savings Program, or
• Receive Supplemental Security Income (SSI).

If that's you, you'll get a letter from Medicare on colored paper letting you know.

Why it's worth checking — even if you've been turned down before

A lot of people assume they earn "too much" and never apply. But the rules have loosened in recent years, and income limits go up each year with the poverty level. If you were denied in the past, your situation — or the limits — may have changed.

It's also worth applying if:

• Your income dropped after retirement or a job change,
• A spouse passed away, or
• You now support other family members in your household.

There's no cost or penalty for applying, and being denied doesn't affect your other Medicare benefits.

How to apply from Spokane Valley

Spokane Valley is in Spokane County, where residents have several ways to apply for Extra Help — all of them free:

1. Online at ssa.gov/extrahelp. The application takes about 10 minutes. 2. By phone with Social Security at 1-800-772-1213 (TTY 1-800-325-0778). 3. In person at a local Social Security office. 4. Through SHIBA, Washington's State Health Insurance Benefits Advisors program (Washington's version of SHIP). Counselors offer free, unbiased help. Call the Washington SHIBA HelpLine at 1-800-562-6900.

If you qualify, you can enroll in — or switch — Part D coverage outside the normal windows. People with Extra Help get a Special Enrollment Period to change drug plans, so you're not stuck waiting until Fall Open Enrollment (Oct. 15 – Dec. 7).

How Extra Help fits with the current Part D rules

The Part D rules in place for 2026 and 2027 are the most consumer-friendly in years:

• The out-of-pocket cap on covered drugs is $2,100 in 2026 and $2,400 in 2027 for any Part D enrollee.
• The coverage gap (donut hole) was eliminated in 2025 — Part D now has just three phases.
• The Medicare Prescription Payment Plan lets anyone with Part D spread drug costs across the year in monthly bills, at no extra charge.

Extra Help stacks on top of these protections. For people on the program, drug costs at the pharmacy stay very low, and the annual out-of-pocket cap acts as a backstop.