There is a federal program that caps what you pay at the pharmacy counter at $5.10 for a generic drug and $12.65 for a brand name, wipes out your drug plan’s premium and deductible entirely, and still goes unclaimed by many of the people who qualify for it. It is called Extra Help, it runs through Medicare and Social Security, and in 2026 a single person can have income up to $23,940 a year and still get it.
Extra Help, formally the Part D Low-Income Subsidy, exists because Medicare drug coverage was never designed to be cheap on a fixed income. For people who qualify, it converts an unpredictable expense into pocket change. Here is how the program works this year, who gets it automatically, and how everyone else applies.
What Extra Help pays for in 2026
The benefit is unusually concrete. According to Medicare’s official summary of 2026 costs under Extra Help, enrollees pay:
A $0 plan premium (the program covers the full premium of a standard plan up to a regional benchmark), a $0 plan deductible, and copays of no more than $5.10 for each covered generic drug and $12.65 for each covered brand-name drug at a network pharmacy. Most prescriptions filled in this country are generics, which is why the typical trip to the counter under Extra Help costs less than the price of lunch.
There is a second layer of protection on top of that. Once your total drug costs for the year (including amounts the program pays on your behalf) reach $2,100 in 2026, your copays drop to $0 for the rest of the year. And people who also have full Medicaid coverage and are in the Qualified Medicare Beneficiary program pay no more than $4.90 per covered drug. Enrollees also owe no Part D late-enrollment penalty while they have Extra Help, and unlike most Medicare beneficiaries, they can switch drug plans as often as once a month if their plan stops fitting.
The income and asset limits this year
Eligibility comes down to two tests, and both are more generous than many people assume. For 2026, Medicare lists the limits as $23,940 in annual income for an individual and $32,460 for a married couple living together, with resource limits of $18,090 and $36,100 respectively. The limits are higher in Alaska and Hawaii, and they typically rise a bit each year.
The resource test is where people wrongly count themselves out. It looks at things like bank accounts, stocks, bonds, and retirement account balances. It does not count your home, your car, or your personal belongings. A couple with a paid-off house, a vehicle, and $30,000 in savings can pass the resource test comfortably.
One caution on the numbers: if your income or savings sit just above the lines, apply anyway. Certain kinds of income and support do not count the way you might expect, and Social Security, not you, makes the final call. You can also reapply any time your finances change.
Who is enrolled automatically
Three groups get Extra Help without filing anything: people with full Medicaid coverage, people whose state pays their Part B premium through a Medicare Savings Program, and people receiving Supplemental Security Income. If you are in one of those groups, a notice arrives in the mail spelling out what you will pay and which drug plan you have been placed in. You can pick a different plan if you prefer.
Everyone else has to raise a hand. That is where the program leaks: eligible people who never applied because they assumed the paperwork was heavy or the answer would be no.
How to apply
The application is shorter than most people fear. You can apply online through Social Security, or call 1-800-772-1213 and ask for an appointment to apply for Part D Extra Help. Before you start, gather bank statements, tax returns, retirement account balances, and statements for pensions, annuities, veterans’ benefits, or Railroad Retirement benefits for you and your spouse.
Two useful side effects of applying: Social Security will forward your information to your state to start a Medicare Savings Program application at the same time unless you tell them not to, which can also get your monthly Part B premium paid. And free, unbiased help with the whole process is available from your State Health Insurance Assistance Program, whose counselors handle these applications constantly.
Once you qualify, the benefit runs through the end of the calendar year even if your income rises mid-year, and it continues into the next year unless you get a notice saying otherwise.
If the pharmacy charges you the wrong amount
Extra Help status does not always reach a plan’s computer system on the first try. If you have qualified and the register still asks for a full copay, contact your drug plan and offer proof of your Extra Help, or call 1-800-MEDICARE and ask them to confirm your subsidy level with the plan. Tell them how many days of medication you have left so the fix gets prioritized. Medicare’s Limited Income Newly Eligible Transition program can also provide temporary drug coverage, and refunds, for people who qualified but were not yet in a plan; keep your pharmacy receipts.
The larger point is simple. This is one of the few benefits in American health care with clean, published numbers: $0 premium, $0 deductible, $5.10 and $12.65 at the counter, $0 after $2,100. If your income is anywhere near the limits, the hour it takes to apply is one of the better-paying hours available to you this year.
This article was produced with AI assistance and reviewed by a human editor. Figures are linked to their primary sources; where a claim could not be verified from the public record, we say so.
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