Extra Help Program for Low-Income Seniors: How to Qualify for Prescription Drug Savings

For many seniors on fixed incomes, paying for prescriptions can feel like a monthly battle. Insulin, heart meds, diabetes drugs - these aren’t optional. But with prices climbing, even a $50 co-pay can mean skipping meals or cutting back on heat. That’s where the Extra Help Program comes in. Officially called the Part D Low-Income Subsidy (LIS), it’s a federal program that slashes out-of-pocket drug costs for Medicare beneficiaries with limited income and resources. Since January 2024, the rules changed dramatically: there’s no more partial help. If you qualify, you get full benefits - and that means $0 premiums, no deductible, and tiny copays on all your meds.

Who Exactly Qualifies for Extra Help?

You don’t need to be broke to qualify. The income limits for 2025 are $23,475 a year for a single person and $31,725 for a married couple living together. That’s not much, but it’s higher than most people think. And here’s the catch: not all income counts. The first $20 of monthly income is ignored. If you work part-time, the first $65 of earned income is exempt, plus half of what’s left after that. Income from a child in military service? Doesn’t count. Tax-exempt interest? Only the amount above the limit matters.

Resources matter too. You can have up to $17,600 in assets as a single person, or $35,130 as a couple. But this doesn’t mean your house, your car, or your jewelry counts. Your primary home? Excluded. One vehicle? Excluded. Personal belongings, furniture, even up to $1,500 set aside for burial expenses? All excluded. What counts? Cash in checking or savings accounts, stocks, bonds, mutual funds, and any real estate besides your home.

How Do You Get Into the Program?

There are three ways to get Extra Help - and the easiest one is if you don’t have to apply at all. If you already get Supplemental Security Income (SSI), Medicaid, or are enrolled in a Medicare Savings Program (MSP), you’re automatically signed up. About 12.5 million people are already in this group. No paperwork. No waiting. You just get the benefits.

If you’re not automatically enrolled, you need to apply. You can do it online at SSA.gov/extrahelp, by calling Social Security at 1-800-772-1213, or by filling out Form SSA-1020 at your local Social Security office. You’ll need your Medicare card, proof of income (like your last tax return or pay stubs), and documentation of your assets (bank statements, investment accounts). The process takes about 3 to 6 weeks. But here’s good news: 87% of applications are processed in 21 days or less.

What Happens When You Qualify?

Once approved, your prescription drug costs drop dramatically. You pay nothing for your Part D plan’s monthly premium - if your plan has a $0 premium option, which most do. The annual deductible? Gone. That $595 you’d normally pay before your coverage kicks in? Eliminated.

Your copays are tiny. 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 ones. If you’re between 100% and 150%, you pay up to $4.90 for generics and $12.15 for brand-name drugs. Compare that to the average $30-$60 co-pay most seniors pay without Extra Help.

And if you’ve been late signing up for Part D before? No penalty. The program wipes out that late enrollment fee - which can add up to hundreds a year. Plus, starting in 2025, all Extra Help recipients pay no more than $35 a month for insulin and $0 for recommended vaccines like shingles and flu shots.

Why So Many People Miss Out

Even with these generous benefits, nearly 4.3 million eligible seniors aren’t enrolled. That’s over $26 billion in free help going unused every year. Why? Many think they make too much. Others don’t know the program exists. Some are scared of the paperwork. A few even think it’s only for people on Medicaid.

Common mistakes on applications? Miscalculating income by including things that don’t count - like your home equity or SSI payments. Or underreporting assets, like forgetting about a small mutual fund. About 22% of applications are rejected just because documents are incomplete. Don’t let that be you.

What If You’re Just Above the Limit?

If your income is a little over $23,475, don’t give up. The program has built-in allowances. If you have high medical expenses, you might still qualify under a special hardship exception. Some states also offer their own assistance programs that can help bridge the gap. Talk to your local State Health Insurance Assistance Program (SHIP) office. They’re free, local, and trained to help seniors navigate these programs.

How to Apply - Step by Step

1. Check if you’re automatically enrolled. Do you get SSI, Medicaid, or a Medicare Savings Program? If yes, you’re already covered. No action needed.

2. Gather your documents. Collect your Medicare card, Social Security number, recent tax return (or proof of income like pay stubs), and bank/asset statements. Don’t forget to list all your savings, investments, and property besides your home.

3. Apply online or by phone. Go to SSA.gov/extrahelp. Fill out the form. It takes about 15 minutes. Or call 1-800-772-1213. Have your documents ready when you call.

4. Wait for confirmation. You’ll get a letter from Social Security within 3-6 weeks. If approved, your Part D plan will be adjusted automatically. If you’re not enrolled in a Part D plan yet, one will be chosen for you - usually a $0 premium plan.

5. Confirm your coverage. Check your new plan’s formulary. Make sure your meds are covered. If not, you can switch during the Annual Enrollment Period (October 15-December 7).

What to Do If Your Application Is Denied

If you’re turned down, don’t accept it as final. You have 60 days to appeal. Look at the denial letter - it should say why. Common reasons: income or assets were listed wrong, or documents were missing. Fix the error, add the missing info, and reapply. Many people get approved on their second try.

You can also get free help from a SHIP counselor. They’ll review your application, help you understand what counts as income, and even call Social Security on your behalf. Find yours at shiptacenter.org.

Is Extra Help Worth It?

Absolutely. The average enrollee saves about $6,200 a year on prescription drugs. For someone taking five or six medications, that’s the difference between eating well and choosing between food and pills. Studies show Extra Help cuts out-of-pocket drug costs by 83% compared to those without it. For seniors with diabetes, heart disease, or arthritis, this isn’t just savings - it’s health security.

And the program keeps getting better. In 2025, the Social Security Administration rolled out a new online tool that automatically checks your eligibility using your tax and benefit data. If you’re likely eligible, you’ll get a letter inviting you to apply. It’s designed to find the 4.3 million people still missing out.

Next Steps

If you or someone you know is a Medicare beneficiary with limited income, don’t wait. Even if you think you don’t qualify, apply. The rules are more flexible than they seem. Call Social Security today. Go online. Talk to a SHIP counselor. The savings are real. The help is there. All you have to do is ask.