Extra Help (Low-Income Subsidy) for Prescription Drugs
Extra Help—also called the Low-Income Subsidy (LIS)—helps people with limited income and resources pay Medicare Part D prescription drug costs, including premiums, deductibles, and copayments.
Educational information only. SubsidyCheck does not determine eligibility, enroll you in a plan, or act as a government agency. Final decisions are made by Medicare, your state Medicaid agency, and licensed plan administrators.
What Extra Help Covers
Extra Help is a federal program that reduces Part D prescription drug costs. Depending on your subsidy level (full or partial), it may pay your plan premium, eliminate or lower your deductible, and reduce copayments for covered medications.
If you receive full Extra Help, you pay no more than a small copayment for each prescription. Partial Extra Help provides smaller reductions. Your subsidy level is determined by Social Security or your state Medicaid agency.
Who May Qualify
You may automatically qualify for Extra Help if you have full Medicaid, receive QMB/SLMB/QI benefits, or participate in a Medicare Savings Program. Others can apply based on income and resource limits set annually by the federal government.
Resource limits include savings, stocks, and bonds but generally exclude your home, one vehicle, and certain other assets. Income limits vary based on whether you are single or married. Social Security makes the final determination for most applicants.
How to Apply
Apply online at SSA.gov, by phone at 1-800-772-1213, or at your local Social Security office. If you have Medicaid, you may already have Extra Help without a separate application.
Once approved, Extra Help lasts for the calendar year unless your circumstances change. You will receive a notice from Social Security confirming your subsidy level. Report income or resource changes promptly.
Extra Help and D-SNPs
Most D-SNPs include Part D drug coverage. If you have Extra Help and join a D-SNP, your drug costs are typically capped at LIS copayment levels for covered medications on the plan's formulary.
Extra Help does not guarantee enrollment in any specific D-SNP. You must still meet dual-eligible criteria and enroll during a valid enrollment period. Check that your medications are on the plan's formulary before switching.
Maintaining Your Subsidy
Annual redetermination may occur if you applied based on income rather than automatic qualification. Keep Social Security and Medicaid updated with address and income changes.
Losing Extra Help can significantly increase drug costs. If you receive a notice of termination, contact Social Security immediately to appeal or reapply if your circumstances qualify.
Frequently asked questions
Is Extra Help the same as Medicaid?
No. Extra Help is a Medicare program for Part D drug costs. Medicaid is a broader state program. Many Medicaid recipients automatically receive Extra Help.
Can I use Extra Help with any Part D plan?
Extra Help works with any Medicare Part D plan or Medicare Advantage plan that includes drug coverage, including D-SNPs. Compare formularies to ensure your drugs are covered.
What if my income is slightly above the limit?
You may still qualify if you have high medical expenses or live in certain living arrangements. Social Security reviews each application individually.
Do I need to reapply every year?
Automatic qualifiers typically do not need to reapply. Income-based recipients may need annual redetermination.
Sources & official references
Related D-SNP guides
Curious whether a D-SNP may fit your situation?
Take our educational eligibility check. It does not enroll you in a plan or guarantee benefits.