Medicare Part D

2024 rules widen Medicare Extra Help in Waukesha

In Waukesha, Wisconsin, many people on Medicare are quietly paying more for prescriptions than they need to. A federal program called Extra Help — also known as the Low-Income Subsidy, or LIS — can lower what people with limited income pay for Part D drug coverage. And thanks to changes that took full effect in 2024, more people qualify than ever before.

If you or someone you love is on Medicare in Waukesha County, it's worth a fresh look at Extra Help as you consider 2027 coverage. Here's what to know, and the common missteps to avoid.

What Extra Help actually does

Extra Help is a federal benefit that reduces the cost of Medicare's prescription drug coverage (Part D). If you qualify, it can lower or eliminate your Part D monthly premium, wipe out the yearly deductible, and cap what you pay at the pharmacy counter for covered drugs.

Under a change from the Inflation Reduction Act, the "partial" Extra Help level was eliminated in 2024. Now everyone who qualifies gets the full subsidy — there is no longer a smaller, partial benefit.

Who qualifies in 2027

Eligibility is based on income and resources (things like money in the bank, stocks, and bonds — but not your home or car). For 2025, the income limit was set at 150% of the federal poverty level, and Social Security updates the figures each year. For a current single filer, that's roughly around $23,000 in yearly income, with higher limits for married couples. Resource limits are also higher than most people expect — well over $17,000 for an individual.

A few important points:

• You can still qualify even if you work.
• Some income, like certain in-kind help from family, doesn't count.
• If you already have Medicaid, Supplemental Security Income (SSI), or a Medicare Savings Program, you're automatically enrolled in Extra Help — no separate application needed.

Because the numbers change each year, check the current limits at medicare.gov or ssa.gov/extrahelp before assuming you make too much.

The mistakes we see most often

Waukesha residents call their local SHIP counselors with the same problems again and again. The most common ones:

• Assuming you won't qualify. Many people rule themselves out based on old rules. The limits are more generous than they used to be.
• Not reapplying after a life change. Losing a spouse, retiring, or a drop in income can suddenly make you eligible.
• Confusing programs. Extra Help is for drug costs. Medicare Savings Programs (QMB, SLMB, QI) help with Part B premiums and other costs. They're separate applications, and many people qualify for both.
• Skipping Part D entirely to save money. Going without drug coverage can trigger a lifelong late-enrollment penalty. Extra Help exists precisely so people don't have to make that choice.

How Extra Help fits with the latest Part D changes

Medicare's drug benefit looks different now than it did just a couple of years ago. The old "donut hole" coverage gap was eliminated in 2025, leaving three simpler phases. The Part D out-of-pocket cap is $2,100 in 2026 and $2,400 in 2027, and the maximum yearly deductible is $615 in 2026 and $700 in 2027.

There's also the Medicare Prescription Payment Plan, which lets you spread your drug costs into monthly payments across the year instead of paying big amounts at the pharmacy at once. It doesn't lower the total cost — Extra Help does that — but it can smooth out the bumps.

For people with Extra Help, costs are already much lower, and these new protections add another safety net.

How to apply

Applying is free. Beware of anyone who charges you or pressures you to sign paperwork.

• Online: ssa.gov/extrahelp
• Phone: Social Security at 1-800-772-1213 (TTY 1-800-325-0778)
• In person: Your local Social Security office
• Free local help: Wisconsin's SHIP program is called the Medigap Helpline / Wisconsin SHIP at 1-800-242-1060. Waukesha County's Aging and Disability Resource Center (ADRC) can also connect you with a benefits specialist.

Once you're approved, Extra Help follows you into whichever Part D or Medicare Advantage drug plan you choose.

A note on plan choices in Waukesha County

Waukesha is in Waukesha County, where Medicare beneficiaries can generally choose from a range of stand-alone Part D plans and Medicare Advantage plans that include drug coverage. Extra Help works with any Medicare-approved drug plan, so qualifying doesn't lock you into one option. If you're comparing plans, the Annual Enrollment Period runs October 15 – December 7, 2026 for coverage starting January 1, 2027, and the Medicare Advantage Open Enrollment Period runs January 1 – March 31, 2027. Your current plan's 2027 details are in its Annual Notice of Change, and the full 2027 lineup is on Medicare.gov's Plan Finder.