Extra Help Program for Low-Income Seniors: How to Qualify for Prescription Drug Savings
If you’re a senior on a fixed income and struggling to pay for your medications, you’re not alone. In 2025, over 15.8 million Medicare beneficiaries rely on the Extra Help Program to cut their prescription drug costs by up to 83%. But here’s the shocking part: nearly 4.3 million people who qualify for this program don’t even know they’re eligible. That’s over $26 billion in free assistance going unused every year.
What Is the Extra Help Program?
The Extra Help Program, officially called the Part D Low-Income Subsidy (LIS), is a federal program run by the Social Security Administration to help low-income Medicare beneficiaries pay for their prescription drugs. Before 2024, there were two levels of help: full and partial. Now, thanks to the Inflation Reduction Act, everyone who qualifies gets the same full benefits-no more confusing tiers.
If you qualify, you pay nothing for your Part D plan premium, your deductible is covered, and your copays for medications are capped at just $1.60 for generics and $4.80 for brand-name drugs. You also won’t face late enrollment penalties, and insulin costs are capped at $35 per month. For someone taking five or more prescriptions a month, that can mean saving over $6,200 a year.
Who Qualifies for Extra Help?
You don’t need to be broke to qualify. The income and resource limits are set each year based on the Federal Poverty Level. In 2025, the thresholds are:
- Individuals: Annual income under $23,475
- Married couples living together: Annual income under $31,725
For resources-things like bank accounts, stocks, bonds, and second properties-the limits are:
- Individuals: $17,600 total
- Married couples: $35,130 total
But here’s what most people get wrong: not everything counts as a resource. Your primary home, one car, household goods, personal items, and up to $1,500 set aside for burial expenses are all excluded. Even your retirement accounts like IRAs and 401(k)s are counted-but only the balance, not future contributions.
And income? It’s not your gross pay. It’s your adjusted gross income (from your tax return) plus any tax-exempt interest. The first $20 of monthly income and the first $65 of earned income (plus half of what’s left after that) are also not counted. If your child is in the military and sends you money, that doesn’t count either.
How Do You Get Extra Help?
You don’t have to apply if you’re already getting certain benefits. About 12.5 million people are automatically enrolled. If you have any of these, you’re already covered:
- Medicaid
- Supplemental Security Income (SSI)
- A Medicare Savings Program (MSP) that pays your Part B premium
- State help paying your Medicare costs
If you’re not automatically enrolled, you can apply in three ways:
- Online: Go to ssa.gov/extrahelp and fill out the form. It takes about 15 minutes.
- By phone: Call Social Security at 1-800-772-1213 (TTY: 1-800-325-0778), Monday through Friday, 8 a.m. to 5:30 p.m.
- In person: Visit your local Social Security office. No appointment needed.
You’ll need to provide:
- Your most recent tax return (or proof of income if you didn’t file)
- Bank statements or account summaries for savings, checking, or investment accounts
- Proof of ownership for any non-primary real estate
Processing usually takes 3 to 6 weeks. But 87% of applications are handled in 21 days or less. If approved, you’ll get a letter from Social Security, and your Part D plan will be switched automatically to a $0 premium option if you’re not already on one.
Common Mistakes That Cause Applications to Be Denied
Over 55% of rejected applications are due to simple errors. Here are the top three:
- Mixing up income types: People include things like SSI, VA benefits, or child support as income-even though they’re excluded. This pushes their income over the limit.
- Overvaluing assets: Listing a second car or vacation property at its full market value instead of its current resale value. SSA uses fair market value, not replacement cost.
- Missing documents: Not submitting tax forms, bank statements, or proof of residency. Even a missing page can delay approval for weeks.
If your application is denied, don’t give up. You can appeal within 60 days. Many people get approved on their second try after correcting the error.
What Happens After You’re Approved?
Once you’re in Extra Help, your drug costs drop dramatically:
- Monthly premiums: $0 for any Part D plan with a $0 premium (most plans in every state offer this)
- Deductible: Fully covered-no need to pay the $595 standard deductible
- Copays: $1.60 for generics, $4.80 for brand-name drugs if your income is at or below 100% of the Federal Poverty Level. If you’re between 100-150%, you pay up to $4.90 for generics and $12.15 for brands
- Gap coverage: You won’t hit the coverage gap (donut hole) because your costs are already capped
- Insulin: No more than $35 per month
- Vaccines: $0 for flu, pneumonia, shingles, and other covered vaccines
And if you’re switching plans, your new coverage starts within 45 days of approval. You won’t lose access to your meds during the transition.
Why So Many Seniors Miss Out
Even though the program has been simplified, many seniors still think they earn too much or own too much to qualify. Some believe it’s only for people on SSI. Others don’t know they can apply even if they’re not on Medicaid.
Geographic differences are stark. In Mississippi, nearly half of all Medicare Part D enrollees get Extra Help. In Minnesota, it’s less than a quarter. That’s not because one state has more poor seniors-it’s because outreach and awareness vary wildly.
Women make up 58% of enrollees. Most are over 75. And nearly 4 in 10 are from racial or ethnic minority groups. These are the people who need help the most-and often have the hardest time navigating the system.
What’s New in 2025 and Beyond
The 2024 reforms didn’t just simplify the program-they expanded it. Now, everyone who qualifies gets the same full benefits, regardless of income level. That added coverage for 1.2 million people who used to get only partial help.
In February 2025, the Social Security Administration launched a new automated screening tool on SSA.gov. It checks your data against tax records, Medicaid rolls, and SSI databases to see if you qualify-without you having to apply. By the end of 2025, it’s expected to find 750,000 new eligible seniors.
By 2027, enrollment is projected to hit 16.9 million. But experts warn: without new funding, the trust fund backing this program could run out by 2041. That’s why applying now isn’t just smart-it’s critical.
What If You’re Just Above the Limit?
Even if your income or resources are slightly over the limit, you might still qualify. Some states offer additional assistance through Medicare Savings Programs that can help you meet the thresholds. And if you have high medical bills, you can request a hardship exemption.
Don’t assume you’re ineligible. Apply anyway. The worst they can say is no. But if you’re approved, you’ll be saving hundreds-sometimes thousands-on your meds every year.
Next Steps: What to Do Today
Don’t wait. Here’s your simple action plan:
- Check your income and resources. Add up your bank accounts, investments, and non-home property. Subtract exclusions like your car and burial funds.
- Look at your 2024 tax return. Find your adjusted gross income (line 11 on Form 1040) and add any tax-exempt interest.
- Go to ssa.gov/extrahelp. Fill out the online form. You can save it and come back later.
- Call 1-800-772-1213. If you’re uncomfortable online, a representative can walk you through it.
- Follow up in 3 weeks. If you haven’t heard back, call again. Don’t assume silence means denial.
Every month you wait, you’re paying full price for prescriptions you shouldn’t have to. The system is designed to help you. All you have to do is ask.
Can I still get Extra Help if I have a Medicare Advantage plan?
Yes. Extra Help works with any Medicare Part D plan, including those bundled into Medicare Advantage plans. If you’re enrolled in a Medicare Advantage plan with drug coverage, Extra Help will still lower your copays and eliminate your premium and deductible. You don’t need to switch plans to get the benefit.
Do I have to reapply every year?
No. Once you’re approved, your Extra Help status continues automatically unless your income or resources increase significantly. Social Security will review your case each year using tax and benefit data. If something changes, they’ll notify you. You only need to reapply if you lose eligibility or if you’re asked to update your information.
What if I don’t file taxes?
You can still qualify. If you don’t file taxes, you can provide other proof of income, like Social Security benefit statements, pension letters, or a signed statement from a financial institution. Social Security accepts alternative documentation-just call them to ask what’s acceptable for your situation.
Can I get Extra Help if I’m still working?
Yes. Many seniors work part-time and still qualify. The program looks at your total income after exclusions. The first $20 of monthly income and the first $65 of earned income (plus half of what’s left) don’t count. So if you earn $1,200 a month from a job, only about $570 counts toward your income limit.
What if I’m denied but think I qualify?
You have 60 days to appeal. Review the denial letter-it will say why you were turned down. Common reasons include missing documents or incorrect income calculations. Gather proof that shows your actual income and resources, then submit it with your appeal. Many people are approved on appeal after correcting the error.
Does Extra Help cover over-the-counter medications?
No. Extra Help only applies to prescription drugs covered under Medicare Part D. Over-the-counter medicines like pain relievers, allergy meds, or vitamins are not included. However, some Medicare Advantage plans offer limited OTC benefits as extras-check your plan’s formulary.
i had no idea this existed until my grandma told me last week. she’s been paying $400 a month for her insulin and just found out she pays $35 now? she cried. i cried. we’re applying this week. thank you for this post.
why is the government giving free money to old people who never saved? i worked my whole life and still pay full price for my meds. this is unfair. someone should check how many of these people have luxury cars or second homes. it’s a scam waiting to happen.