Help with drug costs

What's Extra Help?

"Extra Help" is a Medicare program to help people with limited income and resources pay Medicare drug coverage (Part D) premiums, deductibles, coinsurance, and other costs. What’s a premium, deductible, coinsurance, or copayment?

You also won't have to pay a Part D late enrollment penalty while you get Extra Help. What's the Part D penalty?

Some people qualify for Extra Help automatically, and other people have to apply.

Who gets Extra Help automatically?

You'll get Extra Help automatically if you get:

You'll get a letter about your Extra Help. It tells you things like how much you'll pay, and your new Medicare drug plan, if you don't have one already.

If you don’t automatically get Extra Help, you can apply for it:

Apply for Extra Help

Or call Social Security at 1-800-772-1213. TTY users can call 1-800-325-0778.

You can apply for Extra Help and Medicare Savings Programs (MSPs) at the same time. These state programs provide help with other Medicare costs. Social Security will send information to your state to initiate an MSP application unless you tell them not to on the Extra Help application. Learn more about Medicare Savings Programs.

Who should apply for Extra Help?

In most cases, to qualify for Extra Help, you must have income and resources below a certain limit. These limits go up each year.

The income limit is based on your income from the previous year.

Income and resource limits in 2022:

Your situation: Income limit: Resource limit:
What counts in resource limits?
Individual $20,385 $15,510
Married couple $27,465 $30,950

If you qualify for Extra Help

We’ll automatically enroll you in a Medicare drug plan (Part D) , if you don’t have one already. We do this so you can get the cost savings you qualify for.

  • You’ll get a letter telling you:
    • About your new plan. You can pick a different Medicare drug plan if you want.
    • What you’ll pay, depending on the “level” of Extra Help you get.
    • That you get Extra Help for the rest of the calendar year. Even if your income changes in the middle of the year, you’ll keep getting Extra Help through December 31.
  • If you meet the income and resource limits for next year, you’ll keep getting Extra Help. We’ll mail you a letter only if:
    • Your Extra Help changes.
    • You no longer qualify for Extra Help.
    • You get moved to a different plan for next year.
  • If you don’t get a letter from Medicare or Social Security, you’ll keep the same level of Extra Help and same plan for next year.
Extra Help Level: In 2022, you'll pay:
Full Extra Help

Plan premium: $0

Plan deductible: $0

Prescriptions:

  • Up to $3.95 for each generic drug ($4.15 in 2023)
  • Up to $9.85 for each brand-name drug ($10.35 in 2023)

Once your total drug costs (what both you and your plan pay) reach $7,050 ($7,400 in 2023), you’ll pay $0 for each covered drug.

If you also get full Medicaid coverage and are in the Qualified Medicare Beneficiary (QMB) program, you’ll pay no more than $4.30 for each covered drug. Find out if you may qualify for QMB or other Medicare Savings Programs.
Partial Extra Help

Plan premium: Varies based on your income. Plan premiums if you have Partial Extra Help

Plan deductible: No more than $99 ($104 in 2023)

Prescriptions: No more than 15% of the cost for each covered drug

Once the total drug costs (what both you and your plan pay) reach $7,050 ($7,400 in 2023), you’ll pay no more than:

  • $3.95 for each generic drug  ($4.15 in 2023)
  • $9.85 for each brand-name drug ($10.35 in 2023)

Learn more about the letters you get when you qualify for Extra Help.
 

Even if you don’t qualify for Extra Help now, you can reapply for Extra Help any time if your income and resources change.

Do you think you're paying the wrong amount for your prescription(s)?

If you qualify for Extra Help and think you’re paying the wrong amount, here’s what you can do:

Tell your plan how many days of medication you have left. Your plan and Medicare will try to fix your issue before you run out of your medication.
  • Call us at 1-800-MEDICARE (1-800-633-4227). TTY users can call 1-877-486-2048. We can tell you your level of Extra Help and help you get your costs fixed with the plan.

You may be able to get some money back if you:

  • Paid for prescriptions after you qualified for Extra Help
  • Aren’t in a Medicare drug plan

Keep your receipts with your prescription drug prices, and call Medicare's Limited Income Newly Eligible Transition (NET) Program at
1-800-783-1307. TTY users can call 711.

Other ways to lower your prescription drug costs:  

What do you want to do next?