Extra Help With Prescription Costs
- Last updated
- October 10, 2026
- Read time
- 5 min
Key points
- Extra Help pays most or all of the monthly cost of a Medicare drug plan. You have no deductible to meet first.
- In 2026, you pay no more than $5.10 for a generic drug and $12.65 for a brand-name drug.
- You may qualify in 2026 with income up to $23,940 a year for one person, or $32,460 for a couple.
- If you have Medicaid, a Medicare Savings Program or Supplemental Security Income (SSI), you get Extra Help without applying.
Extra Help is a Medicare program for people with low income and savings. It lowers what you pay for your drug plan and at the pharmacy. That can make a real difference if you've skipped a refill or cut pills in half to make a check last. The Social Security Administration (SSA) decides who qualifies. You can apply online at ssa.gov, by phone at 1-800-772-1213, or by mail with form SSA-1020.
You may qualify if
- You have Medicare and live in one of the 50 states or Washington, DC.
- You make less than about $1,995 a month for one person, or $2,705 for a married couple.
- Your savings are under $18,090 for one person, or $36,100 for a couple, and your home and one car don't count.
Not sure you qualify? Apply anyway, because Social Security decides, and you can apply again any time your income or savings change. If you would rather not do it alone, a Pair Team advocate can help you apply.
What you pay with and without Extra Help in 2026
| Cost | Most people in 2026 | With Extra Help in 2026 |
|---|---|---|
| Monthly cost of your drug plan | Set by each plan | $0 in many plans |
| Deductible (what you pay before the plan starts to pay) | Up to $615 | $0 |
| Each generic drug | Often 25% of the price | Up to $5.10 |
| Each brand-name drug | Often 25% of the price | Up to $12.65 |
| Most you pay for drugs in a year | $2,100 | $0 after total costs reach $2,100, counting what Extra Help paid |
Since 2024, everyone who qualifies gets full Extra Help, for incomes up to 150% of the poverty level.
From January 1, 2027, the copays are $5.80 and $14.40, and the yearly cap is $2,400.
Who gets Extra Help without applying?
You get Extra Help without applying if you have full Medicaid, a Medicare Savings Program, or SSI. SSI is a monthly check from Social Security for people with very little money. Medicare mails you a letter that says what you'll pay. If you have no drug plan, Medicare puts you in one, and you can switch.
When you apply for Extra Help, Social Security tells your state, and the state starts a Medicare Savings Program application for you. You can say no on the form. That program can pay the $202.90 a month Medicare costs you, usually taken out of your Social Security check. To see how Medicaid fits in, read Medicare and Medicaid together. State phone numbers are on Medicare help in California and Medicare help in New York.
What counts as income and savings?
Income includes Social Security, pensions, wages, veterans benefits, rent you collect, and alimony, Medicare.gov says. Food benefits from the Supplemental Nutrition Assistance Program (SNAP), once called food stamps, don't count. Neither does help with rent or energy bills.
Savings means money in checking, savings and retirement accounts, plus stocks and bonds. These things don't count as savings:
- Your home and one car
- A burial plot, and up to $1,500 you set aside for burial
- Furniture and other things in your home
If you're married and live together, use the limits for a couple.
How to apply
- Get your papers ready, so you have the numbers the form asks for. Have your Medicare card, recent bank statements, and your Social Security or pension letters.
- Apply in one of three ways, whichever is easiest for you:
- Online, through Social Security's website at ssa.gov/medicare/part-d-extra-help.
- By phone at 1-800-772-1213, from 8 a.m. to 7 p.m., Monday to Friday, and TTY users can call 1-800-325-0778.
- By mail with form SSA-1020, the Application for Help with Medicare Prescription Drug Plan Costs.
- Get free help if you want it. Your State Health Insurance Assistance Program (SHIP) helps people apply, and you can call 1-877-839-2675 to find yours.
- Watch for a letter from Social Security, because it tells you if you qualify.
- Be in a drug plan, because you need a Medicare drug plan to use Extra Help. If you don't pick one, Medicare will.
What a Pair Team advocate does
When someone calls us about the cost of their pills, there is usually more going on. Often the monthly Medicare cost is eating into a small check, or getting to the pharmacy is hard. This is what we do:
- Check in one call if you likely qualify for Extra Help, a Medicare Savings Program or Medicaid.
- Help you fill out the Extra Help form and follow up with Social Security until you have a letter.
- Call your drug plan with you if the pharmacy charges more than the Extra Help price.
- Help with what usually comes with it: rides to the pharmacy and the doctor, food, utilities and housing.
An advocate is covered by Medicare if you qualify. It takes two minutes to find out.
Check if you qualify for a Pair Team advocate
Frequently asked questions
Do I have to apply for Extra Help again every year?
You usually don't have to apply for Extra Help again every year, because it keeps going if you still meet the limits. You only get a letter if you no longer qualify or your plan changes. If your income goes up during the year, you keep Extra Help through December 31. If a letter says you no longer qualify, you can apply again.
Can I get Extra Help with a Medicare Advantage plan?
Yes, you can get Extra Help with a Medicare Advantage plan if it includes drug coverage.
What if the pharmacy charges me more than the Extra Help price?
If the pharmacy charges you more than the Extra Help price, call your drug plan. Tell them how many days of pills you have left, and they may ask for proof, like your Extra Help letter. If it's still wrong, call 1-800-MEDICARE (1-800-633-4227).
Does Extra Help get rid of the late penalty?
Yes, you don't pay the late penalty while you get Extra Help. The late penalty is an extra amount added to your drug plan cost if you signed up late.
I need medicine now and have no drug plan. What can I do?
If you need medicine now and have no drug plan, call the Limited Income Newly Eligible Transition (LI NET) program at 1-800-783-1307. It's a Medicare program that gives short-term drug coverage while you wait to join a plan. Keep your receipts, because you may get money back.
What is the Medicare Prescription Payment Plan?
The Medicare Prescription Payment Plan lets you pay for your drugs in monthly bills from your plan, from January to December. It costs nothing to join, but it doesn't lower what you owe. To lower your costs, apply for Extra Help.
Sources
- Help with drug costs, Medicare.gov
- Apply for Medicare Part D Extra Help program, Social Security Administration
- SSA-1020 Forms, Social Security Administration
- HI 03001.005, Medicare Part D Extra Help (Low-Income Subsidy), Social Security Program Operations Manual
- How much does Medicare drug coverage cost?, Medicare.gov
- What's the Medicare Prescription Payment Plan?, Medicare.gov
- 2024 Medicare Advantage and Part D Final Rule (CMS-4201-F), CMS
- 2026 Medicare Parts A and B Premiums and Deductibles, CMS
- Medicare Part D and Extra Help, 2026, Benefits Plus Learning Center
- State Health Insurance Assistance Programs
About the author
Alison Shmerling
Medical Director
Alison Shmerling is Pair Team's Medical Director. Since 2024, she has overseen its nurse practitioners, nurses and care managers.
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