Medicare Extra Help: who qualifies in 2026 and what it costs

In 2026, a single person on Medicare with income up to $23,940 a year and savings and other countable resources up to $18,090 can qualify for Extra Help, the federal subsidy for Part D drug costs, according to Medicare.gov¹. Someone who qualifies pays no Part D deductible and no more than $5.10 for each covered generic prescription this year.

About 13.6 million Part D enrollees received the subsidy in 2025, out of roughly 56 million people in Part D, according to preliminary figures the Medicare Payment Advisory Commission presented in January 2026⁵. The program's formal name is the Low-Income Subsidy, or LIS, and the two names are used interchangeably.

In 2024 the program grew, when the Inflation Reduction Act extended the full subsidy to everyone with income up to 150 percent of the federal poverty level who meets the resource test, CMS noted in its 2026 guidance². People who once qualified only for partial help now get the full benefit. This explainer sets out the 2026 limits, what enrollees pay, the 2027 amounts CMS has already published, and how to apply.

Who qualifies in 2026

Eligibility rests on two tests, income and resources, and both are checked. The income limit is 150 percent of the federal poverty guideline. HHS set the 2026 guideline for one person in the 48 contiguous states and the District of Columbia at $15,960, and for a two-person household at $21,640, according to HHS's poverty guidelines page³. Medicare's published income limits match 150 percent of those figures.

Sources: HHS³ for the guideline, Medicare.gov¹ for the income limits, CMS² for the resource limits. Limits are higher in Alaska and Hawaii, Medicare.gov notes.

Resources, as CMS defines them² under federal regulation 42 CFR 423.772, include checking and savings accounts, stocks, bonds and other liquid assets that can be turned into cash within 20 days, plus real estate other than the person's home. The higher resource figures in the table include $1,500 per person set aside for burial, for people who tell the Social Security Administration they expect to use some resources that way. CMS raised the resource limits 3.01 percent for 2026, the rise in the Consumer Price Index from September 2024 to September 2025, its guidance shows².

Some people never have to apply. Medicare.gov says enrollment is automatic for anyone who has full-benefit Medicaid, gets help from the state paying Part B premiums through a Medicare Savings Program, or receives Supplemental Security Income, and that those people get a notice in the mail. Extra Help is not available in Puerto Rico or the other US territories, Medicare.gov says¹, though those areas run their own programs.

What enrollees pay at the pharmacy

Copayments depend on which group a person falls into. The table shows the federal maximums for 2026, from CMS's October 2025 memo², and for 2027, from the CY 2027 rate announcement⁴ CMS issued on April 6, 2026. A plan can charge less but not more.

In CMS's tables, the "generic" column covers generics and preferred multiple-source drugs. Since 2024 no Part D enrollee, with or without Extra Help, pays cost sharing for covered drugs once spending reaches the annual threshold, CMS notes². Medicare.gov lists the plan premium under Extra Help as $0, and the subsidy also removes the Part D late enrollment penalty while a person has it, the site says.

For generics specifically, the subsidy makes a measurable difference. In 2022, LIS enrollees paid an average of 59 cents out of pocket per 30-day-equivalent generic prescription, compared with $4.00 for other Part D enrollees, HHS's planning office found in a 2024 analysis⁶. For context on what those generics cost pharmacies, see our NADAC price tracker and what pharmacies pay for a month of common generics.

How to apply

People who do not get Extra Help automatically apply through the Social Security Administration. The online application⁷ is on SSA's secure site, and SSA lists a toll-free number, 1-800-772-1213 (TTY 1-800-325-0778), for help completing it. Medicare.gov adds that local State Health Insurance Assistance Programs give free help applying, and that the same application can start a Medicare Savings Program application with the state unless the applicant opts out, according to Medicare.gov¹.

Several rules follow approval, all described on Medicare.gov's Extra Help page¹:

• Anyone who qualifies and has no drug plan is enrolled in one, and can choose a different plan.
• Extra Help lasts through Dec. 31 even if income changes during the year.
• People with Extra Help or Medicaid may be able to change drug coverage once a month, rather than only during the annual enrollment period.
• A temporary program called LI NET covers people who qualify for Extra Help or Medicaid but are not yet in a drug plan, and can reimburse some covered purchases made after they qualified.
• Anyone who thinks the pharmacy is charging the wrong amount can ask the plan to correct it, and Medicare lists the kinds of proof a plan may ask for.

Extra Help interacts with other programs. Medicare's own guidance on the Medicare Prescription Payment Plan⁸, which spreads drug costs into monthly bills, says that option may not be the best choice for people who get or are eligible for Extra Help; our look at the payment plan's first year has the enrollment data. GxRadar's comparison of patient assistance programs, Extra Help and 340B and our overview of Part D changes in 2025, 2026 and 2027 cover the wider picture, and how Part D pays for generics explains the plan side. Questions about which plan, pharmacy or tier works best for a particular set of prescriptions belong with a pharmacist, the plan, or a local SHIP counselor. Our pharmacy counter desk collects related pieces.

What changes in 2027

The 2027 copayments in the table are already final. Under the CY 2027 rate announcement⁴, the standard Part D deductible rises to $700 and the out-of-pocket threshold to $2,400, while Extra Help enrollees keep a $0 deductible. CMS's 2026 memo said the agency would publish the 2026 income standards after the new poverty guidelines came out, and it updates resource limits each fall using September inflation data, the memo explains². The 2027 resource limits will follow the same CPI formula, using the September 2026 index.