Medicare Extra Help: Lowering Your Part D Drug Costs If You Have Limited Income
Extra Help -- also called the Low Income Subsidy -- can save Medicare beneficiaries $5,000 or more per year on prescription drug costs. Here is who qualifies and how to apply.
Medicare Extra Help: Lowering Your Part D Drug Costs If You Have Limited Income
Medicare Extra Help -- officially called the Low Income Subsidy (LIS) -- is a federal program that dramatically reduces prescription drug costs for Medicare beneficiaries with limited income and resources. It can save qualifying beneficiaries $5,000 or more per year. Yet millions of eligible beneficiaries are not enrolled.
What Extra Help Provides
Extra Help pays for most of your Medicare Part D costs:
Full Extra Help (Level 1):
- No Part D premium (or very low premium)
- No Part D deductible
- Minimal copays: $1.50-$4.50 for generics; $4.50-$10.35 for brand-name drugs (2021 amounts)
- No coverage gap (donut hole)
- No catastrophic cost-sharing
Partial Extra Help (Level 2):
- Reduced Part D premium
- Reduced or no deductible
- Reduced copays
- No coverage gap
Who Qualifies for Extra Help
Income limits (2021 approximate):
- Single: Up to $19,320/year (150% of Federal Poverty Level)
- Married couple: Up to $26,130/year
Resource limits (2021 approximate):
- Single: Up to $14,790 in countable resources
- Married couple: Up to $29,520 in countable resources
What counts as resources:
- Bank accounts (checking, savings, CDs)
- Stocks, bonds, mutual funds
- IRAs and 401(k)s (in some cases)
What does NOT count as resources:
- Your primary home
- One vehicle
- Personal belongings and household items
- Life insurance with cash value up to $1,500
- Burial funds up to $1,500
Automatic Eligibility
You are automatically enrolled in Extra Help -- without applying -- if you have:
- Full Medicaid coverage
- Supplemental Security Income (SSI)
- Membership in a Medicare Savings Program (MSP)
If you are automatically eligible, Social Security will notify you and automatically enroll you in a benchmark Part D plan if you are not already enrolled.
How to Apply for Extra Help
Online: Apply at ssa.gov/extrahelp -- takes about 15 minutes.
By phone: Call Social Security at 1-800-772-1213 (TTY: 1-800-325-0778).
In person: Visit your local Social Security office.
Through SHINE: Florida's free SHINE Medicare counseling program can help you apply. Call 1-800-963-5337.
Medicare Savings Programs: Additional Help with Part B Costs
If you qualify for Extra Help, you may also qualify for a Medicare Savings Program (MSP) -- a state program that helps pay Medicare premiums, deductibles, and coinsurance.
Florida MSP programs:
- Qualified Medicare Beneficiary (QMB): Pays Part A and Part B premiums, deductibles, and coinsurance
- Specified Low-Income Medicare Beneficiary (SLMB): Pays Part B premium only
- Qualifying Individual (QI): Pays Part B premium only (limited slots available)
Apply for MSPs through the Florida Department of Children and Families (myflorida.com/accessflorida).
Reassessing Eligibility Each Year
Extra Help eligibility is reassessed annually. If your income or resources change, your level of Extra Help may change. Social Security will notify you of any changes each fall.
If you lose Extra Help, you have a Special Enrollment Period to switch Part D plans.
We do not offer every plan available in your area. Please contact Medicare.gov or 1-800-MEDICARE to get information on all of your options.
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About the Author
William Gray
Independent Medicare BrokerUS Air Force Veteran · Florida Medicare Specialist
William Gray is an independent Medicare insurance broker based in Daytona Beach and Palm Coast, FL. A US Air Force veteran (A-10 crew chief, Germany), he spent years in corporate insurance before going independent to serve Florida seniors directly. He has helped more than 1,000 clients across Northeast Florida compare Medicare Advantage, Medigap, and Part D plans — always at no cost to the client.
