Extra Help with Medicare drug costs: who qualifies and how to get it
Extra Help is worth several thousand dollars a year to a person who takes brand-name medications, and Social Security estimates that many people who qualify have never applied. The rules changed for the better in 2024: there is now one full level, the limits are higher, and the application is fifteen minutes online. Here is the 2026 version, with the New York specifics and where to apply in the Capital Region.
Extra Help (the Part D Low-Income Subsidy) is a federal Medicare program that pays most of your prescription drug plan costs. In 2026 you qualify with income under $23,940 a year for a single person or $32,460 for a married couple and resources under $18,090 or $36,100 (your home, one car and burial funds don't count). It pays the Part D plan premium up to the regional benchmark, the whole deductible, and caps copays at $5.10 for generics and $12.65 for brand names; it also waives the Part D late-enrollment penalty and lets you change drug plans once a month. You get it automatically with Medicaid, a Medicare Savings Program or SSI; otherwise you apply through Social Security online, by phone at 1-800-772-1213, or at the Albany, Schenectady, Troy or Glens Falls office. I help with the application at no charge.
The 2026 rules at a glance
| Item | Single | Married, living together |
|---|---|---|
| Income limit (yearly) | $23,940 | $32,460 |
| Resource limit | $18,090 | $36,100 |
| Plan premium | $0 up to New York's benchmark (most basic plans; a richer plan can cost the difference) | |
| Deductible | $0 | |
| Copays | Up to $5.10 generic, $12.65 brand name; $0 after $2,100 in total drug costs | |
| Late-enrollment penalty | Waived while you have Extra Help | |
| Plan changes | Once a month, year-round | |
150% of the 2026 federal poverty level. Alaska and Hawaii have higher limits. Since 2024 there is a single full level; the old partial subsidy no longer exists.
What counts, and what doesn't
- Income: Social Security (gross, before the Part B deduction), pensions, wages, annuities, interest and dividends, and income from a spouse you live with. A $20 general disregard and a $65-plus-half earned-income disregard apply, so people slightly over the line often still qualify.
- Resources: checking and savings, CDs, stocks, bonds, mutual funds, IRAs and 401(k)s. Not counted: your home, one vehicle, household goods, life insurance, burial plots, and up to $1,500 per person set aside for burial expenses (already reflected in the limits above).
- Not counted at all: help from family with food or housing, SNAP, energy assistance, tax refunds, and the value of your Medicare or Medicaid coverage.
Who gets it without applying
Medicare enrolls you automatically and mails a notice if you have full Medicaid, if New York pays your Part B premium through a Medicare Savings Program, or if you receive SSI. For a lot of Capital Region retirees the practical route is therefore the state application, not the federal one: New York's MSP has higher income limits (up to $2,494 a month for a single person) and no resource test, and MSP enrollment brings Extra Help with it. If your savings put you over the Extra Help resource limit but your income is under the MSP line, apply for MSP.
How to apply
- Online at ssa.gov/extrahelp. Have your Medicare number, last year's income figures and current account balances. It takes about fifteen minutes and you can save and finish later.
- By phone: 1-800-772-1213, weekdays 8 a.m. to 7 p.m. (TTY 1-800-325-0778). Ask for an appointment to apply for Part D Extra Help; Social Security can take the application by phone.
- In person at a Social Security office; make an appointment first. Capital Region offices, all open weekdays 9 a.m. to 4 p.m.: Albany, 11A Clinton Avenue, Room 430; Schenectady, One Broadway Center, 8th floor; Troy, 120 Hoosick Street, Suite 12A-1; Glens Falls, 67 Warren Street, Suite 1. There is no office in Saratoga Springs or Clifton Park.
- The decision comes by mail, usually within a few weeks. Approval is for the rest of the calendar year at least; Social Security reviews eligibility each fall and writes only if something changes.
- Then pick the plan. Extra Help removes the premium and deductible but not the formulary: your drugs still have to be on the plan's list and your pharmacy in its network. I run your prescriptions against the New York plans and use the monthly change right if a plan lets you down.
Extra Help, the Medicare Savings Program and EPIC
| Program | Run by | Pays | 2026 income limit | Asset test |
|---|---|---|---|---|
| Extra Help | Federal (SSA / Medicare) | Part D premium, deductible, most copays | $23,940 single / $32,460 couple | Yes: $18,090 / $36,100 |
| Medicare Savings Program | New York (county DSS) | Part B premium; QMB also all Medicare cost-sharing; brings Extra Help automatically | QMB $1,856 / $2,509 a month; QI $2,494 / $3,375 a month | No |
| EPIC | New York (DOH) | Part D copays down to $3–$20; premium help at lower incomes | $75,000 single / $100,000 couple, age 65+ | No |
They stack. A typical Capital Region case: income $2,200 a month, $40,000 in savings. Over the Extra Help resource limit, but under the MSP QI line, so the state pays the Part B premium and Extra Help follows automatically; EPIC then covers what's left of the copays. Three programs, one screening. The full comparison is on help paying for Medicare.
How I help
I screen for all three programs in one call, help with the Extra Help application (it can be done on the phone with me), and then choose the Part D or Advantage plan that actually covers your prescriptions at Extra Help prices. There is no fee for any of it; the plan premium is the same whether you enroll through me or directly. Ask for a screening or pick a time.
- Help with drug costs, Extra Help 2026 (Medicare.gov) — $23,940 / $32,460 income; $18,090 / $36,100 resources; $5.10 / $12.65 copays; $2,100 cap; LI NET 1-800-783-1307
- Apply for Medicare Part D Extra Help (Social Security) — online application; 1-800-772-1213
- Extra Help with Medicare prescription drug plan costs (SSA)
- Social Security field office locator (SSA) — Albany, Schenectady, Troy and Glens Falls offices, checked September 16, 2026
- Medicare Savings Programs 2026 (NY Department of Health)
- EPIC program (NY Department of Health)
I do not offer every plan available in your area. Any information I provide is limited to the plans I do offer in your area. Please contact Medicare.gov, 1-800-MEDICARE, or your State Health Insurance Assistance Program for information on all of your options. Not connected with or endorsed by the U.S. government, the Social Security Administration or the federal Medicare program.
Common questions
Short answers to what people ask before they call.
What is Extra Help with Medicare?
A federal program, run by Social Security and Medicare, that pays most Part D prescription drug plan costs for people with limited income and resources. It is also called the Low-Income Subsidy or LIS. It is separate from New York's Medicare Savings Program (which pays the Part B premium) and from EPIC (New York's state drug program), though the three overlap and one application can lead to another.
What are the Extra Help income and resource limits for 2026?
Income under $23,940 a year for a single person or $32,460 for a married couple living together (150% of the federal poverty level), and resources under $18,090 single or $36,100 couple. Resources mean bank accounts, stocks, bonds and IRAs; your home, one vehicle, personal belongings, life insurance and burial plots don't count. Limits rise each year.
What does Extra Help pay for in 2026?
Your Part D plan premium up to the benchmark amount for New York (most basic plans cost nothing), the whole plan deductible, and copays of no more than $5.10 per generic and $12.65 per brand-name prescription. Once your total drug costs reach the $2,100 cap you pay nothing for the rest of the year. Any Part D late-enrollment penalty is waived while you have Extra Help. If you also have full Medicaid and QMB, copays are at most $4.90.
How do I apply for Extra Help?
Online at ssa.gov/extrahelp (about fifteen minutes; you need your Medicare number, income and account balances), by phone at 1-800-772-1213 (TTY 1-800-325-0778), or in person at a Social Security office. In the Capital Region that's Albany (11A Clinton Avenue), Schenectady (One Broadway Center), Troy (120 Hoosick Street) or Glens Falls (67 Warren Street), weekdays 9 to 4, appointment recommended. Social Security also forwards your information to New York to start a Medicare Savings Program application unless you opt out.
Do I get Extra Help automatically?
Yes, if you have full Medicaid, if New York pays your Part B premium through a Medicare Savings Program (QMB or QI), or if you receive SSI. Medicare mails you a notice and enrolls you in a drug plan if you don't have one. Everyone else applies.
I applied years ago and was denied. Should I apply again?
Yes. Since January 2024 the partial level is gone and everyone under 150% of poverty gets the full subsidy, which is a higher cut-off than the old full level. Income and resource limits also rise every year. You can reapply at any time, and a denial has no downside.
Can I change my Part D plan if I have Extra Help?
Yes, once a month, at any time of year; you don't have to wait for the October–December enrollment period. That matters when a plan drops a drug or a pharmacy mid-year.
What is LI NET?
Medicare's Limited Income Newly Eligible Transition program: temporary Part D coverage for people who qualify for Extra Help or Medicaid but aren't in a drug plan yet, so a prescription can be filled the same day. Keep the receipts; call 1-800-783-1307 to be reimbursed for covered drugs bought after you became eligible.
Find out in one call
Your income, your savings and your prescriptions. I tell you whether Extra Help, the Medicare Savings Program or EPIC fits, and help with the application. No fee.