Medicare Part D

Medicare Part D and Extra Help: Fairmont eligibility

FAIRMONT, W.Va. — If prescription costs feel tight on a fixed income, there's a federal program that could ease the squeeze. It's called Extra Help, and it's designed to lower what people with Medicare pay for their Part D prescription drugs. Many people who qualify don't realize it — and they're leaving real support on the table.

Here's a plain-language look at how Extra Help works heading into 2027, who can get it, and how Fairmont-area residents can apply.

What Extra Help actually is

Extra Help — sometimes called the Low-Income Subsidy (LIS) — is a federal program run through Medicare and the Social Security Administration. It helps pay Part D premiums, deductibles, and copays for prescription drugs.

Starting in 2024, the program was expanded so that everyone who qualifies now gets the full subsidy. There's no longer a partial version. That's a meaningful change, because more people qualify than before, and the help is more generous.

According to CMS, people enrolled in Extra Help pay no more than a few dollars for each covered generic or brand-name drug, and their Part D plan premium may be fully or partially covered.

Who qualifies

To qualify for Extra Help, you generally need to meet both an income limit and a resource limit:

• Income: Up to 150% of the federal poverty level. For 2025 applications, that's roughly $23,475 a year for one person and $31,725 for a married couple living together. (Limits are updated each year.)
• Resources: Up to about $17,600 for one person and $35,130 for a married couple. Resources include things like money in checking and savings accounts, stocks, and bonds — but not your home, one car, burial plots, or household belongings.

You may qualify even if you're still working, and certain income (like some help from family for household expenses) may not count. If you're close to the limit, it's worth applying anyway.

Some people are automatically enrolled in Extra Help and don't need to apply. That includes people who have both Medicare and full Medicaid, people who get Supplemental Security Income (SSI), and people enrolled in a Medicare Savings Program through West Virginia Medicaid.

Why it matters more than ever heading into 2027

Even without Extra Help, Part D has meaningful protections:

• The out-of-pocket cap for Part D drugs is $2,100 in 2026 and $2,400 in 2027. Once you hit that amount, you pay $0 for covered drugs the rest of the year.
• The maximum Part D deductible is $615 in 2026 and $700 in 2027.
• The old "donut hole" coverage gap is gone — as of 2025, Part D has just three simpler phases.
• Anyone with Part D can opt into the new Medicare Prescription Payment Plan, which spreads drug costs into monthly installments instead of big one-time bills at the pharmacy.

Extra Help stacks on top of all of that. For someone in Fairmont juggling several prescriptions, that combination can be the difference between filling a medication and skipping it.

How to apply from Fairmont

There are a few ways to apply, and none of them cost anything:

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 office serving Fairmont is located in Clarksburg; call ahead for an appointment. 4. With free local help from West Virginia SHIP (the State Health Insurance Assistance Program). SHIP counselors are trained, unbiased, and don't sell anything. You can reach WV SHIP at 1-877-987-4463.

You can apply for Extra Help any time of year — you don't have to wait for a Medicare enrollment window.

What happens after you're approved

Once you're approved, you'll get a notice from Social Security. If you already have a Part D plan, the subsidy is applied automatically. If you don't have a Part D plan yet, you'll get a Special Enrollment Period to pick one, and you can switch stand-alone Part D plans once a month, with the change taking effect the first day of the following month — a flexibility most people don't have.

Fairmont is in Marion County, where Medicare beneficiaries have a range of stand-alone Part D and Medicare Advantage prescription drug plans to choose from. The county-level plan lineup is set by CMS each year — check your plan's ANOC for 2027 changes and compare what's available in your ZIP code using the Plan Finder at medicare.gov.