What is Medicare Extra Help and who qualifies for it now?
Summary
Medicare Extra Help is a federal program that lowers prescription drug costs for people with Medicare who have limited income and resources. It reduces premiums, deductibles, and copayments for Medicare Part D and sets a cap on yearly out-of-pocket drug spending. Eligibility depends on income, resources, and participation in other assistance programs like Medicaid or Supplemental Security Income (SSI).Key Facts
- Medicare Extra Help is designed to reduce costs for prescription drugs under Medicare Part D.
- In 2026, Extra Help can lower Part D premiums and deductibles to $0 for those who qualify.
- Prescription payments are capped at $5.10 for generic drugs and $12.65 for brand-name drugs for most beneficiaries.
- Those receiving full Medicaid, Medicare Savings Program help, or SSI benefits automatically qualify for Extra Help.
- Income limits for Extra Help eligibility in 2026 are $23,940 for individuals and $32,460 for married couples.
- Resource limits are $18,090 for individuals and $36,100 for married couples, excluding certain assets like a home and one car.
- Beneficiaries receiving Extra Help do not pay a late enrollment penalty for Part D coverage.
- After reaching the $2,100 annual out-of-pocket spending cap on Part D, beneficiaries pay nothing for covered prescriptions for the rest of the year.
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