Extra Help in 2026: Who Qualifies, and What Changed

The numbers first

If your yearly income is under $23,940 as a single person in 2026, or under $32,460 as a married couple living together, and your savings and other countable resources are under $18,090 single or $36,100 married, you may qualify for a federal program called Extra Help.

If you do qualify, here is what your prescription coverage costs in 2026:

• Plan premium: $0
• Plan deductible: $0
• Each generic drug: up to $5.10
• Each brand-name drug: up to $12.65
• Once your covered drug costs reach $2,100 in 2026: $0 for each covered drug for the rest of the year

Those are the numbers. Everything after this is explanation.

What Extra Help is

Extra Help is a federal program that pays most of the cost of Medicare prescription drug coverage for people with limited income and resources. It is sometimes called the Low-Income Subsidy. It is not a plan and it is not charity. It is a subsidy attached to whatever Medicare drug coverage you have.

It is worth being blunt about one thing. Extra Help pays a Medicare agent nothing. There is no commission on it, which is a large part of why you may never have heard it mentioned by anyone whose job involves Medicare. We are telling you about it anyway, and you should weigh that however you like.

Some people already have it and do not know

You get Extra Help automatically, without applying, if any one of these is true:

• You have full Medicaid coverage.
• Your state helps pay your Part B premium — that is a Medicare Savings Program.
• You get Supplemental Security Income payments from Social Security.

If one of those describes you, the subsidy should already be attached to your drug coverage. It is worth confirming rather than assuming, because the way you find out it did not attach properly is at a pharmacy counter, being asked for a number you were not expecting.

If none of those describes you, nothing happens automatically. You have to apply, and applying is the only way in.

The rule that changed, and the old tables still floating around

This one matters, because a lot of what is written about Extra Help online is out of date in a way that costs people money.

Extra Help used to have tiers. There was a full subsidy and there was a partial, sliding-scale version with higher copays for people a little further up the income scale. The partial tier was eliminated as of 2024. Everyone who qualifies now gets the full subsidy.

So if you find a chart showing a sliding scale, or a percentage of the premium, or a middle band with different copays, you are reading something written before 2024. Do not budget around it, and do not let it talk you out of applying because you assumed you would only get a fraction.

What "resources" means, and why you should not talk yourself out of it

The resource limits — $18,090 single and $36,100 married in 2026 — are about savings and things you own that could be turned into cash, not about everything you have.

We are not going to publish a list of what counts and what does not, because the exact treatment of a particular asset is the sort of thing that is easy to get slightly wrong in print and expensive to get wrong in practice. What we will say is that the limits are higher than most people assume, and that the number of people who decide they are not eligible without ever asking is the real problem with this program.

If you are close to the line, or you think you are over it, ask somebody whose job is to answer that question. There is a free way to do that, below.

Extra Help and the late enrollment penalty

If you went without creditable prescription drug coverage and picked up a Part D late enrollment penalty, Extra Help stops that penalty while you have Extra Help.

The word "while" is doing real work in that sentence. It is not a permanent erasure. If your circumstances change and you stop qualifying, the penalty situation changes with it. Anyone who tells you Extra Help cancels the penalty forever is rounding off in a direction that could cost you later.

How to apply, and where to get help doing it

You apply through Social Security — online or by phone. There is no fee to apply and nobody needs to be paid to file it for you.

If you would rather have somebody sit with you while you do it, every state runs a State Health Insurance Assistance Program — SHIP — with counsellors trained on Medicare who do not sell plans and do not work for one. Medicare's own site points people to SHIP for free help applying for Extra Help, which is a fair signal of what the program is for.

• Colorado — 888-696-7213
• Wyoming, the Wyoming State Health Insurance Information Program — 1-800-856-4398
• Nebraska, SHIP and the Senior Medicare Patrol — 1-800-234-7119

Write the one for your state somewhere you will find it again.

Two things worth doing in the same sitting

Check the year on every number. The income limits, the resource limits and the copays above are all 2026 figures and all of them reset in January. The insulin ceiling and the $0 for recommended adult vaccines do not reset — those are set in statute rather than adjusted annually — but everything on this page does. If you are reading this in a later year, the shape of the program is the same and the numbers are not.

Ask about the Medicare Savings Programs at the same time. They are a separate set of programs that help with Part A and Part B costs rather than drug costs, and the qualifying tests are related but not identical. People often turn out to be eligible for one and not the other, and the only way to find that out is to ask about both in the same conversation. That is a genuinely useful twenty minutes.

Where we come into this

Haven Health Plans was started by the pharmacists at Good Day Pharmacy. Good Day operates a network of local community pharmacies across Colorado, Wyoming and Nebraska, and the group is still growing.

We do not pick plans around pharmacies. A recommendation rests on your medication list, your doctors and your budget. Your pharmacy enters the conversation only when you tell us you want to keep it.

On this particular subject there is nothing to sell you at all. If Extra Help is the answer for you, the answer is a Social Security application and a SHIP counsellor, and we will tell you that and be done. We would rather be the ones who told you than have you find out in four years that it was there the whole time.

And the standing rule, here and everywhere else we write: do not stop, skip or reduce a medication on your own over what something costs. Take it to the person who prescribed it. If cost is the real problem, say so plainly to the prescriber and to the pharmacist — there are usually more moves available than people expect, and none of the good ones involve stretching a prescription out.