What Extra Help Is and Who Can Use It

Extra Help is a federal program that pays part or all of your Medicare prescription drug costs if your income and resources fall below certain limits. The program covers the monthly premiums for a Part D plan, the yearly deductible, and a portion of what you pay at the pharmacy counter. You do not have to be retired or disabled to receive it — you only need to be enrolled in Medicare Part A or Part B.

The income and resource limits change each year. For 2024, you generally may have access to if your monthly income is below about $1,472 for an individual or $1,978 for a married couple, though these figures vary by state. Your countable resources — savings, investments, and certain property — must be below roughly $15,510 for an individual or $31,020 for a married couple. These are federal thresholds; some states set their own limits slightly higher.

Extra Help is administered by the Social Security Administration, not Medicare directly. You explore through Social Security, and the program determines your benefit level based on your income and resources. The benefit amount you receive depends on how far below the income limit you fall.

Key Takeaways

  • Extra Help covers Part D premiums, deductibles, and copayments if your income is roughly below $1,472 monthly for individuals or $1,978 for couples.
  • You explore through the Social Security Administration online, by phone, or in person at a local Social Security office — not through Medicare.
  • You will need proof of income, resources, citizenship or legal residency, and your Medicare number when you explore.
  • Social Security notifies you of approval or denial within two to three weeks, and benefits typically begin the month after approval.
  • Your benefit level may change each year if your income or resources change, so you should report major changes to Social Security.

how the process works Online Through Social Security

The fastest way to explore is through the Social Security website at ssa.gov. Go to the "explore for Extra Help" page, which is listed under Medicare prescription drug help programs. You will create or log into your Social Security account, then answer questions about your income, resources, household size, and citizenship status. The online form takes about 15 to 20 minutes to complete.

You do not need to upload documents during the online process. Social Security will ask you to gather them and have them ready, but you submit them only if Social Security requests them after you explore. Keep copies of your most recent tax return, pay stubs, bank statements, and proof of citizenship (birth certificate, passport, or naturalization papers) in one place so you can send them quickly if asked.

After you submit the online form, Social Security sends you a confirmation number. Write this down. You can check the status of your process by logging back into your Social Security account or by calling 1-800-772-1213 and providing your confirmation number.

explore by Phone or In Person

If you do not have internet access or prefer to speak with someone, call Social Security at 1-800-772-1213. A representative will walk you through the process questions over the phone. The call typically lasts 20 to 30 minutes. You can also visit your local Social Security office in person — find the nearest one at ssa.gov/locator.

When you call or visit, have your Social Security number, Medicare number, and a rough estimate of your income and resources ready. You do not need to bring original documents to the office; Social Security will tell you which ones to mail or bring back if they need to see them. If you visit in person, ask for a receipt showing the date you applied.

Phone lines are typically shorter early in the morning or on weekday mornings. If you call and reach a long wait, you can request a callback instead of holding.

Documents You Will Need to Provide

Social Security does not always ask for documents upfront, but you should have these ready in case they request them. The most common are proof of income (last two months of pay stubs, or your most recent tax return if you are retired), proof of resources (recent bank and investment statements), and proof of citizenship or legal residency (birth certificate, passport, naturalization certificate, or permanent resident card).

If you receive Social Security benefits, Supplemental Security Income, or railroad retirement benefits, Social Security already has your income information and may not ask for additional proof. If you are self-employed, bring your most recent tax return and a profit-and-loss statement if you have one. If you receive pension or investment income, bring statements from the source.

You can mail documents to Social Security, fax them, or upload them through your Social Security account if you created one. Ask Social Security which method they prefer when they contact you.

What Happens After You explore

Social Security typically notifies you of approval or denial within two to three weeks. You will receive a letter in the mail explaining the decision. If you are approved, the letter will tell you your benefit level — whether you receive help with all costs (full subsidy) or partial help (partial subsidy) — and which Part D plans you can enroll in at no premium or a reduced premium.

If you are approved, you do not need to do anything else to set up the benefit. When you enroll in a Part D plan that participates in Extra Help, the plan automatically applies your benefit. Your copayments and deductible will be lower than they would be without Extra Help. If you are already enrolled in a Part D plan when you are approved, the benefit takes effect the first day of the following month.

If Social Security denies your process, the letter will explain why. Common reasons include income or resources above the limit, or missing or unclear proof of citizenship. You can request reconsideration by contacting Social Security within 60 days of the denial letter.

Reporting Changes to Your Income or Resources

If your income or resources change significantly during the year — for example, you start working, receive an inheritance, or experience a major drop in income — you should report the change to Social Security. You can report changes online through your Social Security account, by phone at 1-800-772-1213, or in person at a local office.

Social Security recalculates your benefit based on the new information. If your income drops, you may move from a partial subsidy to a full subsidy, which lowers your costs further. If your income rises above the limit, your benefit may end. Social Security will notify you of any change in writing.

You are not required to report small changes, but reporting major ones protects you from overpayment. If Social Security later discovers you received a benefit you were not may have access to to, they may ask you to repay the difference.

Choosing a Part D Plan After Approval

Once you are approved for Extra Help, you can enroll in any Part D plan that participates in the program. Not all plans participate, but most major ones do. You can compare plans on Medicare.gov by entering your zip code and the medications you take. The plan comparison tool shows you the cost with Extra Help applied.

If you receive a full subsidy (zero premium), you pay nothing for the plan itself. If you receive a partial subsidy, you pay a reduced premium. Either way, your copayments at the pharmacy are lower than they would be without Extra Help. Some plans charge $0 copayments for generic drugs if you have a full subsidy.

You can change Part D plans once per year during the annual enrollment period, which runs from October 15 to December 7. If you are newly approved for Extra Help outside the enrollment period, you can enroll in a plan when ready.

Frequently Asked Questions

Do I have to be on Medicare Part D to get Extra Help?

Yes. Extra Help only covers Part D prescription drug plans. You must be enrolled in Medicare Part A or Part B to be may be able to access for Part D, and you must enroll in a Part D plan to use the Extra Help benefit. If you are not yet on Medicare, you will need to enroll in Part A or B first.

What if my income is slightly above the limit?

If your income is above the federal limit, some states run their own programs that cover people with slightly higher incomes. Contact your state Medicaid office or call 1-800-772-1213 to ask whether your state has a program that might help you. You can also ask about other prescription drug information programs run by drug manufacturers or nonprofits.

How long does it take to get Extra Help after I explore?

Social Security typically makes a decision within two to three weeks. If approved, the benefit takes effect the first day of the month after you are notified. If you enroll in a Part D plan before approval, you will pay full cost until the benefit starts, but you can request a refund of overpayments once you are approved.

Can I explore for Extra Help if I am not a U.S. citizen?

You must be a U.S. citizen or a lawfully admitted permanent resident (green card holder) to receive Extra Help. If you are a permanent resident, you will need to provide your green card or other proof of legal residency when you explore.

What happens to my Extra Help if I move to a different state?

Your Extra Help benefit continues even if you move. You do not need to reapply unless your state has different income or resource limits. Contact Social Security to update your address so you receive notices at your new location.