To be honest, Medicare costs a lot of money. If you have a fixed income, even a tiny monthly premium or medication co-pay can feel like a big impact. But millions of seniors don’t know that they can get considerable support through a program called Extra support. This includes no premiums, no deductibles, and controlled prescription expenses.
I’ve worked with elders for more than 20 years, and I’ve seen too many individuals skip visits or go without their meds merely to save a few dollars. You don’t have to do that. If you don’t make much money, Medicare’s Extra Help (sometimes called the Low-Income Subsidy) can pay for most of your drugs, and occasionally all of them.
But here’s the thing: every year, billions of dollars in benefits go unclaimed. Why? Because no one makes this obvious. People think they don’t qualify, or they just don’t know about the program.
In this essay, I’ll explain everything in simple terms: what the program is, who may join, how much money you could save, and what to do next.
By the conclusion, you’ll know if this applies to you or someone you care about, and how to finally stop paying too much for the care you already deserve.
Before we get started, I have a quick question: Have you ever looked into whether you can get any Medicare savings programs?
(If not, you could be missing out on thousands.)
What Is Medicare’s “Extra Help” Program — And Why It’s a Big Deal
Think of Extra Help as a safety net that comes with your plan. It is a federal program that helps people with low incomes pay for their Medicare Part D prescription drugs. That includes premiums, deductibles, and copays, which are the things that discreetly take money out of your Social Security check every month.
You could:
- You don’t have to pay a monthly Part D premium.
- Stay away from the yearly deductible
- Get your medicines for only $0 to $4.50.
- Don’t worry about the donut hole covering gap at all.
This isn’t just a random award or a one-time thing. The Social Security Administration says that it’s continued help worth more than $5,300 a year, month after month, year after year. But millions of older people never apply because no one tells them about it.
The Low-Income Subsidy (LIS) is the official name for this benefit. Most individuals, even some agents, just call it “Extra Help.”
You may automatically qualify if your income is below a specific level and you don’t have much savings. You can also apply on your own, without a lawyer, an advocate, or a lot of paperwork.
Do You Qualify for Extra Help? Let’s Break It Down
The good news is that most individuals don’t think it’s that hard to qualify for Extra Help. You might already be able to get it, but you don’t know it.
Basic Income and Resource Limits (2024)
Your income and savings must be below specific levels in order to qualify. Starting in 2024:
Money:
- Individuals make less than $22,590 a year.
- Couples pay less than $30,660 a year.
- (For singles, that’s around $1,882 a month, and for couples, it’s almost $2,555 a month.)
Savings:
- Individuals pay less than $17,220.
- Couples pay less than $34,360.
This includes money in your bank and savings accounts, stocks, and other assets, but not your home or automobile.
These numbers change a little bit every year, but not by much. It’s worth checking if you’re even close to those numbers.
Who automatically gets more help?
If you already have these things, you immediately qualify:
- Medicaid
- Supplemental Security Income (SSI)
- A Medicare Savings Program (MSP)
If any of those things are true for you, you don’t even need to apply. Social Security or Medicare will send you a letter to confirm it. If you’re enrolled in Medicaid or a Medicare Savings Program, you may already qualify without applying — here’s a guide on Medicare and Medicaid benefits for seniors and how they work together.
What if you don’t automatically qualify?
You can still put up the effort. You don’t need a lawyer or caseworker, and it doesn’t cost anything.
In the next section, we’ll go over the steps one by one.
How Much Money Can Extra Help Actually Save You?
Extra Help isn’t just a discount, so let’s get to the point. It will save you money every month, which may add up to thousands of dollars a year.
If you meet the requirements, you might not have to pay:
- Your Medicare Part D plan doesn’t have a monthly premium.
- No deductible every year (in 2024, that’s generally around $545).
- Low copays: $4.50 or less for generic medications and $11 for brand-name drugs.
- No “donut hole” in coverage
Medicare says that Extra Help is worth an average of $5,300 a year. That’s not a little amount of money; it’s enough for groceries, heating costs, or the choice between getting a prescription filled or not.
Many seniors battling chronic conditions — including heart disease that’s often covered under Medicare — don’t realize they could reduce both treatment and drug costs through Extra Help.
Example from real life:
Let’s say you take five different drugs. With a regular Part D plan, you might have to pay:
- $40 to $50 a month in premiums
- $500 deductible
- $15 to $30 for each prescription
Even with basic coverage, that’s at least $1,500 a year. With Extra Help? Most of that goes away.
But here’s something that most people don’t know:
Extra Help also keeps you safe from unanticipated price increases during the year. Your costs stay low even if your prescription plan changes or the prices of drugs go up. That kind of consistency is hard to find in healthcare, but it’s very important.
The Hidden Gap No One Talks About — The Medicare Cliff
Most stories won’t tell you this, but there is a hidden crisis going on for older folks who are barely above the income line for Extra Help. People who don’t officially qualify for help but nonetheless can’t pay for their care are being impacted by the Medicare Cliff.
Please let me clarify.
For example, let’s imagine you make $100 more than the maximum, maybe because of a tiny pension or some savings. Even if your rent keeps going up, your expenses are high, and your prescriptions cost more than your groceries, that small discrepancy could make you ineligible.
And then what? You have to pay full price, but someone who makes a little less than you gets practically everything covered. That’s the cliff, and it’s very steep.
Why This Happens:
Extra Help has severe rules about how much money and property you can have. There is no middle ground or sliding scale. You either meet all the requirements or you don’t get any support. People in the “gray zone” don’t have anything.
For years, institutions like NCOA and The Commonwealth Fund have been warning people about this. But policy moves slowly, and in the meanwhile, people fall through the cracks.
“We’re watching a slow-motion crisis,” says the NCOA in its 2024 Medicare Cliff report. “Seniors just above the line are skipping meds, going into debt, or withdrawing early from retirement funds to survive.”
What You Can Do If You’re In That Gap:
- Look into state-level assistance programs (we’ll cover that in Section 6)
- Get help from nonprofits like PAN Foundation or BenefitsCheckUp.
- Recalculate your income — sometimes certain costs (like medical expenses or premiums) can be used to bring your “countable income” below the limit
What If You Don’t Qualify? Here’s What You Can Still Do
Don’t give up if you examine the statistics and see that you’re just beyond the restrictions. You can still lower your Medicare expenditures even if you don’t qualify for Extra Help.
All you have to do is know where to look.
1. Look for Medicare Savings Programs (MSPs)
Medicare Savings Programs are handled by each state and can assist pay for:
- Your Part B premiums
- Copays and deductibles
- Maybe even some of the costs of drugs
Most of the time, the income restrictions for MSPs are higher than those for Extra Help. So, even if you don’t meet the requirements for one, you might still meet the requirements for the other.
2. Get help from nonprofit organizations
The PAN Foundation, GoodRx Help, and NeedyMeds are just a few of the groups that help those who can’t afford their medications. They aren’t run by the government, but they cover important gaps.
Some people assist pay for some drugs. Some people give you drugstore discount cards that function even if you don’t have Extra Help.
3. Appeal or Recalculate Your Income
A lot of older people don’t know that you can ask Social Security to revise your income estimate if your situation has changed, like after:
- Ending work
- The death of a partner
- A big medical bill
- A loss of other money, such alimony or a pension
It’s called a “life-changing event,” and it can cut your countable income, which could help you qualify after all.
For the full process, go to here.
How to Apply for Extra Help (Without Getting Overwhelmed)
You don’t need a lawyer. You don’t have to go to an office. And you don’t have to wait until enrollment season to do this.
You can ask for Extra Help at any moment, and it won’t cost you anything.
Even if you don’t like paperwork, here’s how to accomplish it step by step.
Step 1: Get Your Information Together
Get this ready before you start the application:
- Your Social Security number
- Basic information about income, like Social Security, pensions, etc.
- The balances in your bank and investment accounts
- Value of other savings, such as equities, bonds, or CDs
Keep in mind that your home, car, and personal items are not assets.
Step 2: Decide how you want to apply
You can choose from three things:
- The quickest method to do it online is to go to here.
- Call Social Security at 1-800-772-1213.
- In person: Go to your local Social Security office and phone ahead to make an appointment.
The online application is easy to follow and takes roughly 20 to 30 minutes to complete.
You don’t have to be on a Part D plan to apply, but if you are approved, you will need to sign up for one to access the benefits. We’ll talk about that in the next part.
Step 3: Wait for a Decision (Usually a Few Weeks)
Social Security will send you a letter to let you know if you were approved. If you are, the savings will instantly be applied to your drug plan.
If you are denied, you will get a letter stating why. You can then appeal or reapply if your situation changes.
Choosing the Right Part D Plan After You Qualify
Getting Extra Help approved is a major deal, but it’s not the end of the road. You have to be in a Medicare Part D prescription drug plan in order to use your savings.
This is what most people miss: not all plans are the same. If you’re not vigilant, you could land yourself in a plan that doesn’t cover your drugs effectively, even with Extra Help.
Let’s make that better.
Step 1: Know What Extra Help Includes
Extra Help doesn’t choose the plan for you. It pays for the premiums of a benchmark plan (one that costs less than a specific amount in your state), but you still have to pick and sign up for that plan yourself. If you don’t, Medicare will randomly assign you to one.
That’s dangerous, especially if you take a lot of different prescriptions or brand-name ones.
Step 2: Find a Medicare plan with the Medicare Plan Finder Tool
You can use this free tool to:
- Type in your ZIP code
- Put in your pharmacy and medicines.
- See which insurance cover your medications.
- Find out which ones work best with Extra Help.
Look for plans that include the words “premium is covered” or “$0 with Extra Help” next to them. These are the best deals for you.
Step 3: Before you pick a plan, ask yourself these three important questions.
- Are all of my drugs covered?
- Is my favorite drugstore in the network?
- What are the copays after Extra Help is applied?
A $3 difference per month for each medicine can add up quickly. Pick wisely, and don’t just go with the default plan because you think it’s the best.
Step 4: Ask for help if you’re not sure
You don’t have to do it all by yourself. These services are free and trained to help elders choose a plan:
- SHIP counselors (State Health Insurance Assistance Programs) can be found at www.shiphelp.org.
- The NCOA’s Medicare help line is at www.ncoa.org.
- Your local Area Agency on Aging
These specialists can help you compare plans without trying to sell you anything or getting a commission.
If you’re comparing plans, it’s also worth looking at how Medicare Advantage plans stack up against traditional Part D options depending on your needs.
What Happens Next — And How to Keep Your Extra Help
Getting the green light is a big deal. But like everything else with Medicare, there are still some things you need to keep an eye on. If you don’t pay attention, you could lose your Extra Help and not even know it until you get a bill from the pharmacy.
This is what happens when you qualify and how to make sure you stay covered.
1. You’ll get a letter of confirmation.
You will get a letter from Social Security that says:
- When your Extra Help begins
- How much aid you’ll get
- How much you have to spend and what your coverage is like
The letter may tell you how to sign up for a Part D plan if you haven’t already or how a plan will be allocated to you.
This letter is proof that you are eligible.
2. Your costs go down on their own
Your Extra Help discount starts right away when you sign up for a Part D plan. You will see:
- Lower or no premiums
- Instead of full pricing, set copays for medications.
- No more “donut hole” or coverage gap
If your pharmacy costs you more than you thought it would, say something. It could be a mistake on their part, or your plan might not have your Extra Help information on file yet.
3. You’ll be looked at every year
A lot of folks miss this: Extra Help isn’t permanent. Once a year, usually in the fall, Social Security and Medicare check to see if you still qualify.
- They’ll send you a letter requesting you to renew.
- Verify your income and assets
- Tell us about any big changes in your life.
- If you don’t answer, you can lose your benefits, even if you still qualify.
Tip: Put an annual reminder in your calendar to check your mail and respond to Medicare renewal mailings soon away.
4. If anything changes, reapply.
Don’t worry if you lose your eligibility because your income goes up for a short time, such when you get a one-time payout. If your finances change again, you can apply again at any moment.
It’s not a one-time thing. You can always come back.
The Bottom Line — Don’t Miss Out Just Because No One Told You
To be honest, most individuals don’t hear about Extra Help until it’s too late. There is no one from Medicare who phones you. There’s no large letter in the mail. What about the rules? Hard to understand, hidden in small language, and typically made for professionals instead of regular people trying to stay healthy on a tight budget.
But now you do. And that makes everything different.
Extra Help could save you hundreds of dollars a month, maybe even more, if you’re a senior living on a tight budget. It could mean that you can finally afford your prescriptions without having to miss meals or pay your bills. It’s real. You can get it. And it’s not a gift; it’s your right.
I’ve worked with a lot of people who waited too long to apply because no one made it clear. Don’t be one of them.
So here’s what you can do right now:
Do you think you might be able to? You can start the application for free at SSA.
Have you already applied? To earn the full discounts, be sure you are in the right Part D plan.
Do you know someone who needs this? Give it away. This is the kind of thing that makes a big difference in people’s lives.
Let’s finish with this:
You’ve put in a lot of effort your whole life. You’ve put money into the system. You have the right to obtain the help you need, and you shouldn’t feel bad or guilty about needing it.
Don’t miss out just because no one notified you.
Have you or someone you know applied for Extra Help? What was the experience like? Tell your tale; it might be just what someone else needs to finally do what they need to do.
Disclaimer:
This article is for informational purposes only and does not provide legal, financial, or medical advice. Program details and eligibility rules may change. Please consult the official Social Security Administration, Medicare.gov, or a licensed benefits advisor for the most up-to-date and personalized guidance.
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