The Low-Income Subsidy (LIS), also known as the Extra Help program, is a vital federal initiative designed to assist individuals on Medicare with limited income and resources in managing their prescription medication expenses. This program offers crucial financial aid to cover monthly premiums, annual deductibles, and copayments associated with Medicare Part D drug plans.
While the Extra Care Program may not entirely eliminate your out-of-pocket costs, enrolling can lead to substantial reductions in what you spend on necessary medications. It’s an important resource for those needing extra support to afford their healthcare.
If You Currently Benefit from a PAN Grant
Even if you are already receiving assistance from a PAN grant for out-of-pocket medication expenses related to a specific diagnosis, the Extra Care program offers broader coverage. Unlike PAN grants which are diagnosis-specific, Extra Help extends to prescription medications for any health condition. Enrolling in the Extra Care program can significantly lower your overall medication costs, particularly if you require multiple prescriptions for various health needs.
Discover the Benefits of the Extra Help Program
The Extra Care program is designed to significantly ease the financial burden of prescription drugs for eligible individuals, covering almost all related costs. Individuals with Medicare who also qualify for their state’s Medicaid program are automatically enrolled in Extra Help, ensuring seamless access to these crucial benefits.
Looking ahead to 2025, beneficiaries of the Extra Care program can anticipate substantial savings:
- No Plan Deductible: Eliminating upfront costs before coverage begins.
- No Premiums for Part D Drug Plans: Reducing monthly expenses for Medicare drug coverage.
- Significantly Reduced Copays: Paying no more than $12.15 for each brand-name drug covered by the plan and just $4.90 for generic medications.
Check Your Eligibility for Extra Help
Many individuals qualify for Part D Extra Help automatically, simplifying the enrollment process. You don’t need to apply for Extra Help if you fall into any of the following categories; Medicare will proactively inform you about your Extra Help status:
- Dual Enrollment in Medicaid and Medicare: Individuals enrolled in both programs (“dual eligible”) are automatically qualified.
- Receipt of Supplemental Security Income (SSI): Those receiving Supplemental Security Income (SSI) benefits are automatically eligible.
- Qualification for a Medicare Savings Program: Individuals who meet the criteria for a Medicare Savings Program are also automatically enrolled.
Understanding Eligibility Requirements
To be eligible for Extra Help, your income must be below 150 percent of the federal poverty level. For 2025, your total resources or assets must also be at or below the specified limits outlined below.
| 2025: | Income Limit* | Resource Limit** |
|---|---|---|
| Individual | $23,475 | $17,600 |
| Married Couple | $31,725 | $35,130 |
Note: These figures are subject to annual adjustments. While Extra Help is not available in Puerto Rico, the U.S. Virgin Islands, Guam, the Northern Mariana Islands, or American Samoa, residents in these territories may find assistance through state Medicaid programs. *Income limits are higher in Alaska and Hawaii. It’s important to note that if you or your spouse are employed, or if you support other family members living with you, you might still qualify for benefits even if your income slightly exceeds the listed amounts. *Assets include funds in checking, savings, or retirement accounts, as well as stocks and bonds. For more detailed information on income and resource limits, please visit Medicare.gov. You can also learn more about Extra Help at Medicare.gov.
Determine Your Potential Eligibility
While this tool is not a substitute for the official enrollment process, it can help you determine if you might be eligible for benefits:
[Find out if you might be eligible for benefits using our tool:]
DISCLAIMER: This quiz is for informational purposes only and does not replace the official enrollment process. Individuals who appear to be eligible for Extra Help will still need to formally apply through the Social Security Administration. Meeting eligibility criteria does not guarantee enrollment in the program.
Applying for the Extra Care Program
The application process for the Extra Care program requires gathering financial documentation and dedicating some time to complete, but it is a free service. The potential savings make the effort worthwhile.
Mature woman seated in a wheelchair
Alt text: Thoughtful senior woman in wheelchair, symbolizing the Extra Care program’s support for vulnerable individuals.
Essential Information for Your Application
When completing the application for the Extra Help program with the Social Security Administration, you will need to provide details about your income and resources, as well as those of your spouse if you are married and living together.
The online application allows you to save your progress and complete it at your convenience. Family members, caregivers, and other trusted individuals are permitted to assist you in filling out the Extra Help application, making the process more accessible.
Gathering the necessary documents and assessing your assets, both individually and jointly owned, is crucial for a smooth application process. While it may seem like a lot of preparation, remember that the program can lead to significant financial savings on your medications. To help you stay organized, we have created a helpful checklist that you can use, print, or email to yourself below.
Helpful Resources:
Extra Help guide to applying (pdf)
Extra Help application page with helpful information
Application Timeline
You can apply for the Extra Care program annually, at any point throughout the year, providing flexibility and convenience.
Where to Submit Your Application
Assistance with Your Application
State Health Insurance Assistance Programs (SHIPs) offer complimentary support to Medicare beneficiaries and their families, including guidance on applying for the Extra Care program. You can reach them toll-free at 877-839-2675 or visit the SHIP website for local assistance.
What Happens After You Apply
You are not required to submit proof of the information provided in your Extra Care program application initially. However, the Social Security Administration will verify your information against data from other government agencies to ensure accuracy. After submitting your application, the Social Security Administration will review it and send you a notification letter within six weeks to inform you of your Extra Help eligibility status.
Maintaining Your Enrollment
To remain enrolled in the Extra Care program, you must continue to meet the eligibility requirements each year. It is essential to understand the ongoing criteria for maintaining your benefits. Learn more about keeping Extra Help from year to year to ensure continuous coverage.
Additional Strategies to Reduce Prescription Costs
Practical Tips for Saving Money on Prescriptions
If you are concerned about the affordability of your prescription medications, various resources and options are available to help lower your out-of-pocket expenses. Explore our comprehensive guide to discover ways you can lower your prescription costs.
Exploring Financial Assistance Options
Financial assistance for prescription medications is available from diverse sources, including federal and state government programs, non-profit organizations, and private sector initiatives, often involving for-profit companies. Read our guide to patient financial assistance to learn more about these resources.
Expand Your Medicare Knowledge
Explore our Medicare education resources hub to further enhance your understanding of Medicare and related programs.
