What Extra Help is
Extra Help, also called the Low-Income Subsidy (LIS), pays some or all of your Part D costs:
- Part D premium (all of it for some plans, called benchmark plans, and part of it for others)
- Part D deductible
- Per-prescription copays (limited to low set amounts)
| Most you pay per covered prescription, 2026 | Generic | Brand name |
|---|---|---|
| Most people with Extra Help | $5.10 | $12.65 |
| Full Apple Health members with income at or below 100% of the poverty level | $1.60 | $4.90 |
Everyone with Part D also has a yearly out-of-pocket cap ($2,100 in 2026). Once your costs for covered drugs reach it, you pay nothing more for covered Part D drugs that year, including these copays. People with full Apple Health who get long-term care in a nursing facility, or home and community-based services instead, pay nothing for covered Part D drugs.
The 2024 expansion: more people qualify now
Before 2024, Extra Help had separate full and partial levels. Starting in 2024, the Inflation Reduction Act changed this: anyone who qualifies now gets the full benefit, and the income limit is 150% of the federal poverty level.
For 2026, that limit is:
- One person: $23,940 a year (about $1,995 a month)
- Married couple living together: $32,460 a year (about $2,705 a month)
If your income has been near these limits and you didn't qualify before 2024, apply again. The limits rise each year with the federal poverty guidelines; 2027 amounts will appear on Medicare costs in 2027 once they're published.
Resource limits
For 2026, your resources must be below:
- $16,590 for one person ($18,090 if you expect to use some of it for funeral or burial expenses)
- $33,100 for a married couple ($36,100 with the burial allowance)
Resources include bank accounts, stocks, bonds and similar savings. Your home, one car, household goods and personal belongings don't count.
A Washington path around the resource limit: Washington's Medicare Savings Programs have no asset test. If your income fits a Medicare Savings Program (up to 138% of the poverty level for QI-1) but your savings are above Extra Help's limit, apply for the Medicare Savings Program; approval brings Extra Help automatically. See Medicare Savings Programs in Washington.
Who's automatically enrolled
You get Extra Help automatically if you have:
- Full Apple Health (Medicaid)
- Supplemental Security Income (SSI)
- A Medicare Savings Program (QMB, SLMB or QI-1)
If any of these apply to you, you don't need to apply. Medicare mails a notice confirming that you have Extra Help. If you don't choose a drug plan, Medicare enrolls you in one.
Applying for Extra Help
If you don't get it automatically but think you may qualify:
- Apply online at ssa.gov/medicare/part-d-extra-help
- Call Social Security at 1-800-772-1213 (TTY 1-800-325-0778)
- Visit a Social Security office; see Washington Medicare phone numbers and offices
- Or apply for a Medicare Savings Program through Washington Connection, which brings Extra Help with it if you're approved
Social Security mails you its decision. If you're approved, you can join or change a drug plan.
What Extra Help doesn't cover
- Part B premiums (Medicare Savings Programs pay those)
- Part A or Part B cost sharing
- Drugs your Part D plan doesn't cover
- Over-the-counter medicines, unless your plan covers them
Choosing a Part D plan when you have Extra Help
People with Extra Help have more chances to change drug coverage than most people. Since 2025 you can switch to a different standalone Part D plan, or leave a Medicare Advantage plan for Original Medicare with a standalone Part D plan, once a month; the change starts the first day of the next month. You can also change plans during the Annual Enrollment Period (October 15 to December 7, 2026 for 2027 coverage).
Extra Help pays the whole premium of a benchmark plan and part of the premium of other plans, so you may pay a premium if you pick a plan that isn't a benchmark plan. A plan whose drug list and pharmacies fit your prescriptions may still be worth it. For 2027, 4 companies offer 8 standalone Part D plans in Washington (CMS data). If your Medicare Advantage plan ends on December 31, 2026, see Washington Medicare plans ending in 2027.
A licensed insurance agent with Benefits Life can check how your prescriptions work with plans from the companies they work with, at no cost to you. Call (206) SENIORS (206-736-4677), TTY 711, or see plans in your ZIP code.
Coordination with Apple Health
If you have both Medicare and Apple Health, Medicare Part D pays for most of your prescriptions, and Apple Health may cover some drugs Part D excludes by law, such as certain over-the-counter medicines. Ask your pharmacy or your plan. Many people with both programs consider a dual special needs plan (D-SNP); see also Apple Health and Medicare.
Sources
- Medicare.gov — Help with drug costs (Extra Help)
- Social Security — Extra Help with Medicare prescription drug plan costs
- CMS — CY 2026 Resource and Cost-Sharing Limits for Low-Income Subsidy
- Social Security POMS HI 03001.020 — Extra Help income limits (2026 federal poverty level table)
- Medicare.gov — Special Enrollment Periods
- eCFR — 42 CFR 423.38, enrollment periods
- Washington Health Care Authority — Medicare Savings Program (no asset test)
- CMS — CY2027 Landscape file, November 2026 (Washington standalone Part D plan and company counts)
Frequently asked questions
What is Extra Help with Part D?
Extra Help, also called the Low-Income Subsidy (LIS), is a federal program that lowers Part D premiums, deductibles and prescription copays for people with Medicare who have limited income and resources. Social Security decides who qualifies if you apply directly.
Who automatically qualifies for Extra Help?
If you have full Apple Health (Medicaid), Supplemental Security Income (SSI), or a Medicare Savings Program (QMB, SLMB or QI-1), you get Extra Help automatically and don't need to apply separately.
What are the 2026 income limits for Extra Help?
$23,940 a year for one person and $32,460 for a married couple living together, which is 150% of the federal poverty level. Resources must be under $18,090 for one person or $36,100 for a couple, if you plan to use some of them for burial expenses.
How much will I pay for prescriptions with Extra Help?
In 2026, most people with Extra Help pay no more than $5.10 for each covered generic drug and $12.65 for each covered brand-name drug. People with full Apple Health and income at or below 100% of the poverty level pay no more than $1.60 and $4.90.
Can I switch Part D plans more often with Extra Help?
Yes. Since 2025, people with Extra Help or Apple Health can switch to a different standalone Part D plan, or leave a Medicare Advantage plan for Original Medicare with a standalone Part D plan, once a month. The change starts the first day of the next month. This monthly option doesn't let you move from one Medicare Advantage plan to another.
Medicare in your Washington county
Plans, local agents and help, county by county: Adams · Asotin · Benton · Chelan · Clallam · Clark · Columbia · Cowlitz · Douglas · Ferry · Franklin · Garfield · Grant · Grays Harbor · Island · Jefferson · King · Kitsap · Kittitas · Klickitat · Lewis · Lincoln · Mason · Okanogan · Pacific · Pend Oreille · Pierce · San Juan · Skagit · Skamania · Snohomish · Spokane · Stevens · Thurston · Wahkiakum · Walla Walla · Whatcom · Whitman · Yakima
