Many seniors in the U.S. struggle to afford their medications. Even with Medicare Part D, out-of-pocket costs for insulin, heart medications, or diabetes drugs can eat up a fixed income. But there’s a federal program designed specifically to help - the Extra Help Program, also known as the Part D Low-Income Subsidy (LIS). Since January 2024, the rules have changed for the better. If you’re a low-income senior, you may now qualify for full benefits - no more partial help. You could pay $0 for your monthly premium, $1.60 for generics, and $4.80 for brand-name drugs. And you won’t pay any deductible at all.
Who Qualifies for Extra Help?
You don’t need to be broke to qualify. The income limits for 2025 are $23,475 per year for a single person and $31,725 for a married couple living together. These aren’t strict ceilings - the Social Security Administration (SSA) doesn’t count everything you have or earn. For example, the first $20 of monthly income is ignored. Earned income? The first $65, plus half of what’s left after that, doesn’t count. Income from a child in military service? Excluded. Even if your income looks slightly over the limit, you might still qualify after these exclusions are applied.
Resources matter too. You can have up to $17,600 in countable assets as a single person, or $35,130 as a couple. That includes money in bank accounts, stocks, bonds, mutual funds, or real estate you don’t live in. But here’s what doesn’t count: your primary home, one car, personal belongings, household goods, and up to $1,500 set aside for burial expenses. Many seniors think they’re disqualified because they have savings or a small investment account - but if those assets are under the limit and you’ve excluded the right items, you’re likely still eligible.
How Do You Get Extra Help?
You don’t always have to apply. If you already get Supplemental Security Income (SSI), Medicaid, or a Medicare Savings Program (MSP), you’re automatically enrolled. About 12.5 million people got Extra Help this way in 2024. No paperwork. No waiting. If you’re unsure, check your mail - Social Security sends a notice if you’re enrolled automatically.
If you’re not automatically enrolled, you can apply in three ways:
- Online at ssa.gov/extrahelp - this is the fastest method.
- By phone, calling 1-800-772-1213 (TTY: 1-800-325-0778), Monday through Friday, 8 a.m. to 5:30 p.m.
- In person at your local Social Security office - bring your Social Security card, proof of income (like your last tax return or pay stubs), and documentation of your assets (bank statements, investment records).
The application is Form SSA-1020. It asks for details about your income and resources. Most people get a decision in 3 to 6 weeks. SSA data from early 2025 shows 87% of applications are processed within 21 days. If you’re approved, you’ll get a letter confirming your Extra Help status. Then, if you’re not already in a Part D plan, you’ll be automatically enrolled in one with a $0 premium. The whole process - from application to having your drugs covered - takes about 45 days.
What Benefits Do You Actually Get?
Extra Help isn’t just a discount. It removes the biggest financial barriers to getting your meds.
- $0 monthly premiums - You don’t pay anything for Part D plans that offer $0 premiums. These plans are available in every state, with 2 to 7 options per location in 2024.
- No deductible - The standard $595 Part D deductible is gone. You start getting coverage right away.
- Capped copays - If your income is at or below 100% of the Federal Poverty Level, you pay $1.60 for generic drugs and $4.80 for brand-name drugs. If you’re between 100% and 150%, you pay up to $4.90 for generics and $12.15 for brands.
- No late enrollment penalty - If you didn’t sign up for Part D when you were first eligible, you won’t be charged extra now.
- Insulin costs capped at $35/month - Since 2025, all Extra Help recipients pay no more than $35 for each insulin prescription, regardless of brand or type.
- Free vaccines - Flu, pneumonia, and shingles shots are covered at $0 cost.
On average, Extra Help cuts out-of-pocket drug spending by 83%. For someone taking five or more medications, that can mean saving $5,000 to $7,000 a year. The Kaiser Family Foundation says this is one of the most impactful programs for seniors managing chronic conditions.
Common Mistakes That Cause Applications to Be Denied
Many eligible seniors are turned down not because they don’t qualify, but because they make simple errors.
- Overstating income - Including excluded income like the first $20 of monthly income or half of earned income over $65. This caused 18.3% of rejections in 2025.
- Counting the wrong assets - Listing your home, car, or personal items as resources. That led to 14.7% of denials.
- Missing documents - Not providing tax returns, bank statements, or proof of SSI/Medicaid. Incomplete paperwork was the biggest issue - 22.1% of applications were rejected for this reason.
If your application is denied, don’t give up. You can appeal within 60 days. Call Social Security and ask for a reconsideration. Sometimes, a phone interview clears up misunderstandings.
What If You’re Just Above the Income Limit?
You might still qualify. The SSA doesn’t use your gross income - they use your adjusted gross income plus tax-exempt interest, then subtract the exclusions. For example, if you’re a single senior earning $25,000 a year from Social Security and a small pension, but you have $3,000 in tax-exempt municipal bond interest, your countable income might still be under $23,475 after exclusions. It’s worth applying even if you think you’re too rich.
Also, some states offer additional help through Medicare Savings Programs. Even if you don’t qualify for Extra Help, you might qualify for MSP, which pays your Part B premium and automatically triggers Extra Help. Check with your State Health Insurance Assistance Program (SHIP) - they offer free counseling.
Why So Many Seniors Miss Out
Despite the program’s value, about 4.3 million eligible seniors aren’t enrolled. That’s $26.8 billion in unclaimed benefits every year. Why? Many don’t know it exists. Others think they’re too rich, too poor, or that the process is too complicated. Some are afraid of being denied. But the truth is, the system is designed to help. The SSA even launched a new automated screening tool in February 2025 that scans your records to find people who might qualify - no application needed. If you’re on Medicare and get SSI or Medicaid, you’re probably already enrolled. If not, it takes less than 15 minutes to apply online.
The program is growing. Enrollment jumped 4.7% after the 2024 reforms, and by 2027, over 16.9 million seniors are expected to be covered. States like Mississippi have over 48% of their Medicare Part D enrollees in Extra Help. Minnesota has the lowest rate at 22.7% - showing how awareness varies. But the benefit is the same everywhere: lower drug costs, no penalties, and peace of mind.
What Happens After You’re Approved?
Once approved, you don’t have to reapply every year - unless your income or resources change significantly. Social Security will review your case automatically, usually once a year. If your situation improves, they’ll notify you. If it doesn’t, your Extra Help continues.
You’ll be enrolled in a Part D plan automatically if you’re not already in one. If you are in a plan, your costs will be adjusted immediately. You’ll see the savings on your pharmacy receipt. No need to switch plans unless you want to - Extra Help works with any Medicare Part D plan, including those offered by private insurers like Humana, UnitedHealthcare, or Aetna.
And if you’re waiting for approval and need medication now? There’s a temporary program called LINET, run by Humana, that gives you up to two months of free prescription coverage while your Extra Help application is being processed.
Can I get Extra Help if I have a Medicare Advantage plan?
Yes. Extra Help works with any Medicare Part D coverage, including those bundled into Medicare Advantage plans. If you’re approved, your copays and premiums will be reduced automatically - no need to change plans.
Do I have to reapply every year?
No. Once you’re approved, your Extra Help continues unless your income or resources rise above the limits. Social Security reviews your case automatically each year. If they need more info, they’ll contact you.
What if I’m married but my spouse doesn’t live with me?
If you’re legally married but don’t live together, your spouse’s income and resources aren’t counted. You can apply as a single person. You’ll need to provide proof of separate households, like separate utility bills or lease agreements.
Can I get Extra Help if I’m still working?
Yes. Many seniors work part-time or get income from consulting or rental property. Extra Help considers your total countable income after exclusions. If your adjusted income is under $23,475 (or $31,725 if married and living together), you qualify - even if you’re employed.
Is Extra Help affected by the Inflation Reduction Act?
Yes. The Inflation Reduction Act of 2022 eliminated the old partial Extra Help category. Now, everyone who qualifies gets full benefits. It also capped insulin at $35/month and made vaccines free - benefits that now apply to all Extra Help recipients, even those who previously only got partial help.
Next Steps: What to Do Now
If you’re a senior on a fixed income and take prescription drugs, don’t wait. Apply today. Go to ssa.gov/extrahelp and fill out the online form. Have your Social Security number, tax return, and bank statements ready. If you don’t have internet access, call 1-800-772-1213. You can also visit your local Social Security office - no appointment needed.
Don’t assume you’re not eligible. Many people think they make too much - but after exclusions, they qualify. Others think they have too many assets - but their home, car, and personal items don’t count. The program is there to help. And right now, millions of seniors are missing out on thousands of dollars in savings every year. You don’t have to be one of them.
Joe bailey
November 26, 2025 AT 05:09Just applied online last week-took 12 minutes, no stress. Got approved in 14 days. Now my insulin costs $35 instead of $300. My dog’s vet bill is higher than my meds now. Life’s weird, but this? This is beautiful.
Amanda Wong
November 27, 2025 AT 22:51Let me guess-you’re one of those people who think the government owes you free medicine. This program is just another slippery slope toward socialism. Next they’ll pay for your botox and your cat’s thyroid meds.
james thomas
November 29, 2025 AT 17:01They’re not telling you the whole story. The SSA uses your tax returns from 2 years ago, but if you had a one-time capital gain last year? Boom-you’re disqualified. They’ll take your house next. I’ve seen it happen. This isn’t help-it’s a trap to get you on their radar.
Deborah Williams
November 30, 2025 AT 05:38It’s fascinating how we’ve turned healthcare into a bureaucratic obstacle course where the only thing more expensive than the drugs is the emotional labor of applying for relief. We celebrate the fact that seniors are now allowed to survive, as if that was ever in question. The real tragedy isn’t the cost of insulin-it’s that we need a form to justify not dying.
Kaushik Das
December 1, 2025 AT 13:53Bro, this is golden. I’m from India, and here, if you’re over 60 and on a pension, you’re basically invisible to the system. But this? This is actual human care. I shared this with my cousin in Chicago-she was crying because she’s been skipping doses. Now she’s applying. This isn’t policy-it’s dignity.
Asia Roveda
December 1, 2025 AT 16:05So now the government is giving away free meds to people who didn’t plan ahead? What about the people who worked their whole lives and saved? This is just rewarding poor choices. I paid for my own prescriptions. Why should I subsidize someone else’s laziness?
Micaela Yarman
December 3, 2025 AT 11:21It is imperative to underscore the significance of this federal initiative, which constitutes a monumental advancement in the domain of pharmaceutical accessibility for the geriatric demographic. The structural recalibration of eligibility criteria, particularly with regard to the exclusion of primary residences and motor vehicles from asset calculations, represents a paradigmatic shift toward equity in health care delivery.
Aaron Whong
December 5, 2025 AT 04:03The extrahelp program is essentially a neoliberal interventionist mechanism that depoliticizes systemic underfunding of geriatric pharmacoeconomics by individualizing responsibility. The algorithmic exclusion of income streams and asset thresholds are performative gestures that reinforce the hegemony of bureaucratic legitimacy while obscuring the underlying commodification of life-sustaining pharmaceuticals.
Joe bailey
December 6, 2025 AT 17:52And then there’s the guy who says it’s socialism. Dude, I’m 72. I paid taxes for 50 years. My wife died of cancer because we couldn’t afford her chemo. Now I’m getting insulin for $35. If that’s socialism, then sign me up for communism too.