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Yes. Medicare’s Extra Help program can pay some or all of eligible Part D premiums, deductibles, coinsurance and other covered drug costs for people with limited income and resources. It also prevents the Part D late-enrollment penalty while you receive the benefit.
You may qualify automatically through Medicaid, a Medicare Savings Program or Supplemental Security Income (SSI). If you do not, you can apply through Social Security. State prescription programs, manufacturer assistance and a careful comparison of Part D plans can provide additional savings or make bills easier to manage.
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What Extra Help pays
Medicare defines Extra Help as assistance with Medicare prescription-drug (Part D) premiums, deductibles, coinsurance and other Part D costs. The amount of help depends on your income, resources and circumstances. A person receiving Extra Help does not owe the Part D late-enrollment penalty during the period of eligibility. Read the program details on Medicare’s Help with drug costs page.
Extra Help applies to Part D coverage, not every Medicare expense. You still need to understand the premiums and cost-sharing rules of the drug plan you enroll in, because plans and pharmacies charge different amounts.
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2026 income and resource limits
Medicare’s 2026 national limits are shown below. They are screening thresholds, not a personal eligibility decision. Alaska and Hawaii use higher limits, and exclusions or state rules can change how your finances are counted.
| Household | Annual income limit | Resource limit |
|---|---|---|
| Individual | $23,940 | $18,090 |
| Married couple | $32,460 | $36,100 |
These figures come from Medicare’s 2026 guidance and its April 2026 publication, Save on your Medicare drug costs with Extra Help. Verify the current rules before deciding that you are over the limit.
What counts as a resource
Medicare lists money in checking and savings accounts, retirement accounts, stocks and bonds among resources that may be counted. A home, personal belongings, one car, burial plots, certain money set aside for burial, furniture and other household or personal items are listed as exclusions. The treatment of a particular account or asset can depend on the rule and your circumstances, so report information accurately rather than making your own exclusions.
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Medicare generally provides Extra Help automatically when you have full-benefit Medicaid, receive state help paying your Medicare Part B premium through a Medicare Savings Program, or receive SSI payments. You should receive a notice explaining the benefit. If you qualify but do not have a Part D plan, Medicare may enroll you in one automatically and notify you; you can select a different plan if the assigned plan does not cover your medicines or use your preferred pharmacy.
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How to apply if you are not automatically eligible
People who do not qualify through one of the automatic routes can apply for Extra Help through Social Security. Medicare also directs applicants to free counseling from their state Health Insurance Assistance Program (SHIP).
- Check the current rules. Review the income, resource and Alaska/Hawaii qualifications on Medicare’s Extra Help information.
- Gather household details. Have income records and information about bank, retirement and investment accounts available. Include your marital status and the information requested for a spouse when the application requires it.
- Submit the Social Security application. Use the application route identified by Medicare and Social Security. If you are unsure which documents or figures apply, ask a SHIP counselor to help; SHIP assistance is free.
- Read the decision notice. Keep the notice and follow any request for verification. The notice should explain whether you qualify and what happens with your Part D coverage.
- Review your drug plan. Once Extra Help is in place, compare available Part D plans using your actual prescriptions and pharmacy. You may change plans when Medicare rules allow, even if Medicare initially enrolled you.
Applying is worthwhile even when your income appears close to a limit. The published thresholds do not capture every exclusion or state variation, and only the administering agency can make the determination.
Medicare Savings Programs can unlock Extra Help
Medicare Savings Programs are state-administered programs that pay certain Medicare costs. Qualifying for QMB, SLMB or QI also gives you Extra Help for Part D. Their 2026 federal monthly income and resource limits are:
| Program | Monthly income limit, individual | Monthly income limit, couple | Resource limit, individual / couple |
|---|---|---|---|
| Qualified Medicare Beneficiary (QMB) | $1,350 | $1,824 | $9,950 / $14,910 |
| Specified Low-Income Medicare Beneficiary (SLMB) | $1,616 | $2,184 | $9,950 / $14,910 |
| Qualified Individual (QI) | $1,816 | $2,455 | $9,950 / $14,910 |
See the program descriptions and current qualifications at Medicare Savings Programs. Medicare says Alaska and Hawaii limits are higher, and some states allow eligibility above the federal figures.
What each program does beyond Part D
- QMB: pays specified Medicare Part A and Part B premiums and cost-sharing, in addition to conferring Extra Help.
- SLMB: pays the Part B premium and provides Extra Help.
- QI: pays the Part B premium and provides Extra Help. You must reapply every year; funding is limited, applications are first-come, first-served, and prior beneficiaries receive priority.
Apply through your state Medicaid office or the agency identified by Medicare. A denial from one program does not necessarily mean you cannot qualify for another, because their income bands differ.
Other programs that may reduce a prescription bill
State Pharmaceutical Assistance Programs
Some states operate State Pharmaceutical Assistance Programs (SPAPs). Eligibility, covered drugs, premiums and coordination with Part D differ by state. Use Medicare’s guidance to locate your state’s current program and confirm its rules before relying on a discount. There is no single national SPAP application.
Drug-manufacturer patient assistance
Medicare’s Helpful tools page links to a Pharmaceutical Assistance Program finder. These programs are medicine-specific. A manufacturer may limit assistance by diagnosis, income, insurance status or product, and a program may not pay a Part D premium. Ask the program how its help coordinates with your Part D plan before enrolling.
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Medicare Prescription Payment Plan
The Medicare Prescription Payment Plan lets a Part D enrollee spread covered prescription out-of-pocket costs across the calendar year instead of paying the full amount at the pharmacy. It does not lower the price or save money; it changes payment timing. Details, enrollment instructions and cautions are on Medicare’s “Will this payment option help me?” page.
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This option may help with a large early-year bill, but ask the plan for the monthly amount, billing schedule and what happens if you change plans or stop using the pharmacy. It is a budgeting tool, not a substitute for Extra Help or other financial assistance.
Compare your actual Part D costs
Even with assistance, the plan you choose affects what you pay. Medicare reports that Part D premiums vary by plan and can be higher for people subject to an income-related adjustment. Deductibles, copayments and coinsurance vary by both plan and pharmacy. Medicare’s cost overview explains these differences.
- List every prescription. Record the exact drug name, strength, dosage and quantity. Include medicines you expect to refill throughout the year.
- Enter your preferred pharmacies. A plan’s price can change by pharmacy, and a low premium is not automatically the lowest annual cost.
- Compare the full-year estimate. Look at the premium, deductible, copay or coinsurance for each medicine and the plan’s rules for the pharmacies you use.
- Check coverage details. Confirm that each drug is on the formulary and note any utilization rules shown by the plan tool. Ask the plan about alternatives before switching a prescription.
- Recheck after an eligibility change. If Extra Help, Medicaid or a Savings Program starts or ends, run the comparison again and review notices about enrollment or plan changes.
Plan costs are personal: two people with the same premium can have very different annual spending because their medicines, quantities and pharmacies differ.
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- Using gross assumptions about assets. Do not count every possession automatically or omit an account because you believe it is excluded. Report what the application asks for and let the agency apply the rule.
- Treating national limits as universal. Alaska, Hawaii and some state programs use different thresholds. Check your state’s current requirements.
- Assuming automatic enrollment means the plan is ideal. Automatic enrollment provides coverage, but the assigned plan may not be the best match for your medicines or pharmacy. Compare plans and change when permitted.
- Confusing a payment plan with a discount. Spreading payments does not reduce the total amount owed.
- Expecting manufacturer help to cover everything. Patient-assistance programs are tied to specific medicines and may have insurance restrictions. Obtain written eligibility and coordination details.
- Ignoring annual QI renewal. QI funding is limited and requires a new application each year. Mark the renewal period and respond promptly to state notices.
- Paying for application help. SHIP counselors provide free assistance. Be cautious of anyone charging to submit a standard Extra Help or Savings Program application.
Illustrative eligibility checks
These examples show how to use the published limits; they are not eligibility determinations.
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Single beneficiary near the Extra Help limit
A single person with annual income of $23,500 and $17,500 in countable resources falls below the listed 2026 national thresholds. The person should still apply and document the figures, because the agency must verify income, resources and exclusions.
Married couple over the national income figure
A couple with annual income of $33,000 is above the published $32,460 national threshold for Extra Help. They should not assume that all assistance is unavailable: Alaska or Hawaii rules, state variations, Medicaid, a Medicare Savings Program, an SPAP or a medicine-specific program could produce a different result.
Person denied Extra Help but facing a large bill
Someone who does not receive Extra Help can ask the state about Savings Programs and SPAPs, check the manufacturer-assistance finder, and compare Part D plans. If the problem is timing rather than total cost, the Prescription Payment Plan may spread payments but will not reduce the bill.
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Start with Medicare’s Extra Help page for eligibility and application directions. A local SHIP counselor can explain the application, help review notices and discuss plan choices without charging a fee. For Savings Programs, contact your state Medicaid agency. For a specific medicine, use the manufacturer-assistance finder and confirm eligibility directly with the program. Keep copies of every application, notice and plan comparison so you can respond quickly if information changes.
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