Dear Marci,
I have Medicare Part D, and my doctor recently prescribed me a few new medications that Iām struggling to afford. I heard that the Extra Help program can help pay for Part D costs. What is Extra help and how do I know if Iām eligible for it?
Deepa (Warba, MN)
Dear Deepa,Ā
You are correct!Ā Extra Help,Ā also called the Low-Income Subsidy (LIS), is a program that lowers Part D costsāboth premiums and out-of-pocket expenses. Your income and assets (meaning your savings and other resources) determine if youāre eligible for Extra Help. Keep reading for a more detailed explanation of the benefits of Extra Help and its eligibility criteria.Ā
What is Extra Help?Ā
Extra Help is a federal program that lowers premiums and helps pay for out-of-pocket costs associated with Medicare prescription drug coverage. The Extra Help program:Ā
- Pays your Part D premium for a basic Part D planĀ up to a state-specific benchmark amount.Ā Ā
- Lower your costs for prescription drugsĀ by eliminating the deductible period and capping coinsurance and copays.Ā Ā
- Allows you more flexibility to change your Part D plan during the year through aĀ Special Enrollment Period.Ā Ā
- Eliminates the Part D late enrollment period (LEP), if you have one.Ā Ā
Extra Help EligibilityĀ
- In 2025, you may be eligible for Extra Help if your monthly income is up to $1,976 ($2,664 for couples) and yourĀ assetsĀ are below $17,600 ($35,130 for couples). See theĀ Extra Help income and asset limit chartĀ for details.Ā
- Even if your income or assets are above the eligibility limits, you could still qualify for Extra Help because certain types of income and some assets are not counted.
- If you haveĀ Medicaid,Ā Supplemental Security Income (SSI), or aĀ Medicare Savings Program (MSP), youĀ automatically qualify for Extra HelpĀ regardless of whether you meet Extra Helpās income and asset eligibility requirements.Ā Ā
Keep in mind that Extra Help is not a replacement for Part D or a plan on its own. Extra Help works with your plan by reducing your costs.Ā You must still have a Part D plan to have Medicare prescription drug coverage.Ā Ā
Hope this helps!Ā
-Marci