Lower Medicare Part D costs
Medicare Extra Help With Medicaid or a Medicare Savings Program
Extra Help—also called the Part D Low-Income Subsidy or LIS—reduces prescription-plan costs. Full Medicaid, qualifying Medicare Savings Program assistance and SSI can provide automatic eligibility.
Who gets Extra Help automatically?
Full-benefit Medicaid
People receiving full Medicaid generally receive Extra Help automatically.
State help with Part B
People receiving help from a state paying the Part B premium through a Medicare Savings Program generally receive Extra Help automatically.
SSI
People receiving Supplemental Security Income payments from Social Security generally receive Extra Help automatically.
If Medicare’s system has not yet reflected the qualifying status, the drug plan may request proof so the correct subsidy can be applied.
Extra Help costs in 2026
$0 plan premium and deductible
Medicare lists a $0 plan premium and $0 plan deductible under Extra Help in 2026 when the plan and premium fall within applicable subsidy rules.
Covered prescription copayments
At participating pharmacies, the standard 2026 maximums are $5.10 for a generic drug and $12.65 for a brand-name drug.
Lower QMB-plus-full-Medicaid amount
Medicare states that people with full Medicaid who are also in QMB pay no more than $4.90 for each covered drug in 2026.
$0 after the annual threshold
After total covered drug costs reach $2,100 in 2026, the member pays $0 for each covered Part D drug.
What Extra Help changes—and what it does not
| Question | Extra Help effect |
|---|---|
| Part D premium | Can reduce the premium to $0 for an applicable benchmark-level plan; a higher-premium plan can leave an amount due. |
| Part D deductible | $0 under 2026 Extra Help. |
| Covered-drug copayments | Limited to the applicable LIS amount. |
| Formulary | The drug still must be covered or approved through the plan’s exception process. |
| Pharmacy network | The pharmacy still must participate, and plan pharmacy pricing rules still matter. |
| Medicare Part A and B costs | Extra Help does not pay medical cost sharing; Medicaid or an MSP may provide separate medical assistance. |
| D-SNP eligibility | Extra Help by itself does not necessarily qualify someone for a D-SNP; the plan requires an accepted Medicaid category. |
Applying when Extra Help is not automatic
For 2026, Medicare lists annual income limits of $23,940 for an individual and $32,460 for a married couple, with resource limits of $18,090 and $36,100 respectively. Counting rules and exclusions matter.
- Apply online through Social Security or use the SSA-1020 application.
- Allow Social Security to send information to the state to initiate an MSP application unless there is a specific reason to opt out.
- Save the approval notice showing the effective date and subsidy status.
- Confirm that the Part D plan has applied the correct level before the next refill.
Changing prescription coverage under the current Dual/LIS SEP
Since January 1, 2025, people with Medicaid or Extra Help may use the Dual/LIS Special Enrollment Period to elect a standalone Part D plan in any month. This is not an unrestricted monthly right to move into any Medicare Advantage plan.
Full-benefit dual members may have a separate monthly Integrated Care SEP to join an eligible integrated D-SNP when alignment requirements are satisfied. Read the complete D-SNP and Dual/LIS enrollment guide before changing coverage.
Extra Help and Medicaid FAQ
Is Extra Help the same as Medicaid?
No. Extra Help is a Medicare Part D subsidy. Medicaid and Medicare Savings Programs are state-administered assistance programs that may also trigger automatic Extra Help eligibility.
Does Extra Help make every prescription free?
No. Covered-drug copayments are reduced, but the formulary, pharmacy network and coverage rules still apply.
Can someone qualify for Extra Help without Medicaid?
Yes. A person who does not qualify automatically can apply through Social Security and may qualify under the Extra Help income and resource rules.
Will Medicare enroll me in a drug plan?
Medicare may automatically enroll an eligible person who lacks Part D coverage. The person can generally select a different suitable Part D plan.
Can someone with Extra Help change any Medicare Advantage plan monthly?
No. The monthly Dual/LIS SEP is for standalone Part D elections. Monthly enrollment into an integrated D-SNP requires the separate Integrated Care SEP and its eligibility and alignment rules.
Related dual-eligibility and Medicare guides
Make sure the drug plan still covers the prescriptions
Benjamin Thompson can compare available Part D or D-SNP coverage using the exact medications, dosages, pharmacies and eligibility status. Social Security, Medicare and the state determine subsidy eligibility.
This article provides general educational information and does not determine Medicaid, Medicare Savings Program, Extra Help or D-SNP eligibility. Program rules, limits, benefits, networks, formularies and enrollment rights can change. Verify the exact person’s status with Medicare, the applicable state Medicaid agency and the plan before changing coverage. Thompson Medicare Brokerage is not connected with or endorsed by the U.S. government or the federal Medicare program.