Medicare Supplement

Extra Help With Medicare Drug Costs in Worcester for 2026

WORCESTER, Mass. — If you live in Worcester and take prescription medications, there's a federal program that could quietly do a lot of heavy lifting for your budget. It's called Extra Help, also known as the Low-Income Subsidy (LIS). It helps people with Medicare pay for their Part D prescription drug plan — including premiums, deductibles, and the cost of medications at the pharmacy counter.

Worcester seniors may qualify for major drug cost relief

The program isn't new, but recent changes have made it easier to qualify. And with Part D getting a big makeover in 2026, understanding what Extra Help does — and whether you qualify — is worth a few minutes of your time.

What Extra Help actually covers

Extra Help is run by the Social Security Administration and works alongside your Medicare Part D drug coverage. If you qualify, it can lower or eliminate your Part D premium, wipe out your deductible, and cap what you pay for covered drugs at a small amount per prescription.

As of 2024, the program was expanded so that everyone who qualifies gets the full subsidy — there's no longer a partial version. That means if you're eligible at all, you get the whole benefit.

Extra Help works on top of the broader Part D changes taking effect in 2026, which include:

• A new $2,100 out-of-pocket cap on covered prescription drugs.
• A Part D deductible maximum of $615.
• The elimination of the old coverage gap (the "donut hole"), which went away in 2025. Part D now has just three phases.
• The Medicare Prescription Payment Plan, an optional program that lets you spread your drug costs across the year in monthly installments instead of paying big bills at the pharmacy.

Who qualifies in Worcester

Extra Help is based on your income and resources, not your ZIP code — but the guidelines matter for every Worcester resident to know.

For 2025 (the most recent figures published by Medicare), you may qualify if:

• Your annual income is at or below roughly 150% of the federal poverty level (about $23,475 for a single person and $31,725 for a married couple living together — slightly higher in some cases).
• Your resources — things like money in checking, savings, stocks, and bonds — are below program limits (about $17,600 for an individual and $35,130 for a couple in 2025).

Your home, one car, burial plots, personal belongings, and life insurance generally don't count as resources.

You automatically get Extra Help — no application needed — if you already have:

• Medicaid (MassHealth in Massachusetts),
• A Medicare Savings Program, or
• Supplemental Security Income (SSI).

Everyone else has to apply.

How to apply

There are three ways to apply, and all of them are free:

1. Online at ssa.gov/extrahelp. 2. By phone with Social Security at 1-800-772-1213 (TTY 1-800-325-0778). 3. By mail or in person at a local Social Security office. Worcester has an SSA office on Front Street downtown.

The application is short — about 10 minutes for most people. You'll need basic information about your income, savings, and any investments. Social Security will send you a decision letter, usually within a few weeks.

If you're denied, you can appeal. And you can reapply anytime your financial situation changes.

What's available in the Worcester area

Worcester is in Worcester County, where Medicare beneficiaries have a wide selection of stand-alone Part D drug plans and Medicare Advantage plans that include drug coverage. The exact plan count changes each year, and CMS publishes the current lineup on medicare.gov.

If you qualify for Extra Help, you can enroll in a Part D plan, switch plans, or drop coverage once per calendar quarter during the first three quarters of the year — a special enrollment right that most people don't have. The regular Annual Enrollment Period (Oct. 15 – Dec. 7) and the Medicare Advantage Open Enrollment Period (Jan. 1 – March 31) also apply.

Why 2026 makes this worth revisiting

Two things are happening at once. First, Part D's design has changed dramatically — no more donut hole, and a hard $2,100 cap on out-of-pocket drug spending. Second, Extra Help is now an all-or-nothing benefit at a higher income threshold than in past years.

Put those together and there are Worcester residents who didn't qualify a few years ago who probably qualify now. If you were denied in the past, it's worth checking again.

For context on higher-income rules, IRMAA — the income-related surcharge that applies to Part B and Part D premiums — only kicks in above $109,000 for a single filer in 2026. That's a completely different program from Extra Help, but people sometimes confuse the two.