For many seniors on Medicare, paying for daily medications feels like a second mortgage. If you take multiple generic drugs - like blood pressure pills, statins, or diabetes meds - your monthly copays can add up to hundreds of dollars. But there’s a federal program designed specifically to cut those costs to just a few dollars per prescription: Medicare Extra Help.
What Medicare Extra Help Actually Covers
Medicare Extra Help, also called the Part D Low-Income Subsidy (LIS), is a government program that pays for most of your prescription drug costs. If you qualify, you pay nothing for your Part D plan premium or deductible. For generic drugs, your copay is capped at $4.90 per prescription in 2025. That’s it. No hidden fees. No surprise bills.
Compare that to standard Medicare Part D, where you might pay a $595 deductible first, then 25% of the drug cost after that. A $50 generic drug would cost you $12.50 after the deductible - and that’s just one pill. If you take 12 generics a month, that’s $748 a year in copays alone - not counting premiums or the deductible. With Extra Help, it’s $705.60 a year for the same meds, but without the $595 deductible or monthly premium. That’s over $1,300 saved annually.
Some people qualify for even lower costs. If you’re enrolled in both Medicare and Medicaid and your income is below 100% of the Federal Poverty Level, your generic copay drops to just $1.60 per prescription.
Who Qualifies for Extra Help in 2025
Eligibility is based on two things: your income and your resources. It’s not about how much you spend - it’s about how much you have and earn.
For 2025, the income limits are:
- Individual: $23,475 per year
- Married couple living together: $31,725 per year
Your income includes Social Security, pensions, wages, and veterans’ benefits. But it doesn’t include housing assistance, food stamps, or medical care payments.
Resource limits are just as strict:
- Individual: $17,600 total
- Married couple: $35,130 total
Resources include bank accounts, stocks, bonds, mutual funds, IRAs, and savings. Your primary home, one car, and personal belongings don’t count. You also get a $1,500 allowance for burial expenses that doesn’t count toward your total.
These numbers seem low - and they are. Many seniors who live paycheck to paycheck still don’t qualify because they’re $200 over the limit. That’s called the “cliff effect,” and it leaves thousands without help even though they’re struggling.
How to Apply for Extra Help
You don’t need to be a paperwork expert to apply. There are three easy ways:
- Apply online at ssa.gov (the fastest method)
- Call Social Security at 1-800-772-1213
- Visit your local Social Security office
If you already get Supplemental Security Income (SSI), Medicaid, or a Medicare Savings Program, you’re automatically enrolled. No application needed.
For everyone else, the process takes 3 to 6 weeks. You’ll need:
- Your Social Security number
- Proof of income (Social Security award letter, pension statement, or tax return)
- Details of your bank accounts, investments, and other assets
Most people need help filling out the form. That’s normal. State Health Insurance Assistance Programs (SHIPs) offer free, one-on-one help nationwide. Find yours by calling 1-800-MEDICARE or visiting medicare.gov.
What Happens After You Get Extra Help
Once approved, your Part D plan will automatically adjust your copays. You’ll start paying $4.90 (or $1.60) for every generic drug at any pharmacy that accepts Medicare.
You also get special enrollment rights: you can switch your Part D plan once a month, instead of just once a year. That’s huge if your current plan doesn’t cover your meds or has a bad pharmacy network.
Every August, you’ll get a form in the mail to renew your Extra Help for the next year. You have 30 days to return it. If you don’t, your benefits stop on January 1 - even if your situation hasn’t changed. Many people lose coverage not because they earned too much, but because they missed the deadline.
Real Stories: The Good, the Bad, and the Ugly
One woman in Ohio, 78, takes six generic prescriptions a month. Before Extra Help, she was skipping doses to make her money last. After applying, her monthly cost dropped from $280 to $58. She told her SHIP counselor: “I can finally sleep at night.”
But another man in California made $500 more than the income limit after a small Social Security cost-of-living increase. He lost Extra Help overnight. His monthly generic drug bill jumped from $60 to $1,200. He couldn’t afford to refill his heart medication. He ended up in the ER.
These aren’t rare cases. In 2024, 37% of eligible seniors didn’t enroll - mostly because they didn’t know about it or found the process too confusing. Another 42% had trouble with the annual renewal. That’s not a flaw in the program - it’s a flaw in how it’s communicated.
What Extra Help Doesn’t Cover
Extra Help doesn’t pay for non-formulary drugs unless you get an exception. If your doctor prescribes a brand-name drug that’s not on your plan’s list, you’ll need to file a form with your Part D plan. Extra Help makes this easier - you’re more likely to get approved.
It also doesn’t cover over-the-counter meds, vitamins, or supplements. You still pay full price for those.
And while Extra Help eliminates the “donut hole” (the coverage gap where you pay more out of pocket), that’s already gone for everyone in 2025 thanks to the Inflation Reduction Act. So now, Extra Help’s real power is in the low, predictable copays and the elimination of premiums and deductibles.
Why This Matters More Than You Think
Studies show that seniors with Extra Help are 23 percentage points more likely to take their meds as prescribed. That means fewer hospital visits, fewer ER trips, and longer, healthier lives.
For people with diabetes, heart disease, or arthritis - conditions that require daily meds - Extra Help isn’t a luxury. It’s survival.
And the program is growing. In 2023, 15.2 million people got Extra Help. That’s nearly 3 out of every 10 Medicare Part D enrollees. The government is spending over $52 billion on it in 2025. That’s more than ever before.
There’s talk of expanding eligibility to include people with incomes up to 175% of the poverty level - which would add over a million more seniors. If that happens, it could change how America treats aging and healthcare.
What to Do Next
If you’re on Medicare and take any generic prescriptions, check your eligibility now. Even if you think you make too much, apply anyway. The income limits are strict, but sometimes people don’t realize what counts as income or resources.
Don’t wait until your meds run out. Don’t wait for a bill to arrive. Go to ssa.gov or call 1-800-772-1213. Ask for help from your local SHIP. You don’t need to understand the rules - just ask someone who does.
Medicare Extra Help was created so no one has to choose between food and medicine. It works. But only if you use it.
Do I have to reapply for Extra Help every year?
Yes. Every August, you’ll get a form in the mail from Social Security to renew your Extra Help for the next year. You must return it within 30 days. If you don’t, your benefits stop on January 1 - even if your income hasn’t changed. Most people who lose Extra Help do so because they missed this deadline, not because they earned too much.
Can I still get Extra Help if I have savings in the bank?
It depends. You can have up to $17,600 in resources (like savings, stocks, or bonds) and still qualify as an individual. But your primary home, one car, and personal items don’t count. Also, you get a $1,500 allowance for burial expenses that’s not included. If your total countable resources are under the limit, you’re still eligible - even if you have $10,000 in a savings account.
What if my income goes up a little and I lose Extra Help?
Losing Extra Help because of a small income increase is called the “cliff effect.” If your income rises just above the limit - say, from $23,400 to $23,600 - you lose all benefits, even though you’re still struggling. There’s no sliding scale. You go from paying $4.90 per generic to paying full price. This is a major flaw in the program, and advocates are pushing to fix it.
Can I use Extra Help with any Part D plan?
Yes. Extra Help works with any Medicare Part D plan. But not all plans cover the same drugs. Make sure your plan includes the generic medications you take. Extra Help gives you the freedom to switch plans once a month, so you can find the best one for your prescriptions.
Do I have to be on Medicaid to get Extra Help?
No. You can get Extra Help even if you’re not on Medicaid. But if you are on Medicaid, you’re automatically enrolled. Extra Help is a separate program, though the two often work together. People who qualify for both usually get the lowest copays: $1.60 for generics instead of $4.90.
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