By Warren Howard | January 24, 2026| 1 Comments

If you’re a senior on a fixed income and struggling to pay for your medications, you’re not alone. In 2025, over 15.8 million Medicare beneficiaries rely on the Extra Help Program to cut their prescription drug costs - and many more could qualify but don’t know it. The good news? The program got simpler and stronger in 2024. You no longer have to worry about partial benefits. If you qualify, you get full help - meaning $0 premiums, no deductible, and tiny copays for your meds.

Who 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 as low as you might think. For example, if you get Social Security, a small pension, and a bit of interest from savings, you might still be under the limit after accounting for exclusions.

The program looks at your countable income, not your gross pay. That means the first $20 of any monthly income is ignored. Earned income? The first $65 is tax-free, and then only half of what’s left counts. So if you earn $1,000 a month from part-time work, only $467.50 counts toward your income limit. That’s a big difference.

Your resources matter too - but not everything you own counts. Your home, one car, your furniture, and personal items are all excluded. Even up to $1,500 set aside for burial costs doesn’t count. What does count? Cash in bank accounts, stocks, bonds, mutual funds, and any real estate besides your primary home.

The resource limit is $17,600 for individuals and $35,130 for couples. That’s more than most seniors have in savings. Many people think they’re too rich for Extra Help - but they’re counting their house or car by mistake. That’s why so many miss out.

How Do You Get Extra Help?

There are three ways to get enrolled - and two of them require no paperwork 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. No form. No call. No waiting. You’ll get a letter from Social Security confirming your enrollment. About 12.5 million people are enrolled this way.

If you don’t get those benefits, you’ll need to apply. You can do it online at ssa.gov/extrahelp, by phone at 1-800-772-1213, or in person at your local Social Security office. The form is SSA-1020. It’s only three pages long. Don’t let the length scare you.

You’ll need to provide proof of income - like your last tax return, Social Security award letter, or recent pay stubs. For resources, you’ll need bank statements or investment account summaries. Don’t worry if you don’t have everything right away. Social Security will help you get what’s missing.

Processing usually takes 3 to 6 weeks. But in early 2025, 87% of applications were completed in 21 days or less. Approval rates are high - 72% of first-time applicants get approved. If you’re denied, don’t give up. Many denials happen because people miscount their income or forget to list exclusions.

What Does Extra Help Actually Cover?

Once you’re in, the savings are real. Here’s what you get:

  • $0 monthly Part D premiums - if your plan offers one. Most do. In 2024, 2 to 7 plans per state had $0 premiums for Extra Help members.
  • No deductible - you don’t pay the $595 yearly deductible most Part D plans charge.
  • Low copays - $1.60 for generics, $4.80 for brand-name drugs if your income is at or below 100% of the Federal Poverty Level. If you’re between 100% and 150%, you pay up to $4.90 for generics and $12.15 for brand names.
  • No late enrollment penalty - even if you didn’t sign up for Part D when you were first eligible, you won’t be charged extra.
  • $35 monthly cap on insulin - since January 2025, all Extra Help beneficiaries pay no more than $35 per prescription for insulin, no matter the plan.
  • $0 vaccines - flu, shingles, pneumonia, and other recommended shots cost you nothing.

On average, Extra Help cuts out-of-pocket drug costs by 83%. For someone taking five or six prescriptions a month, that’s hundreds of dollars saved every month. One woman in Ohio told her local Area Agency on Aging she went from spending $420 a month on meds to just $38 after enrolling.

Senior couple at a kitchen table with icons showing income exclusions and an 'Eligible!' stamp.

What If You’re Just Above the Income Limit?

Many people think if they make $25,000 a year, they’re out of luck. But that’s not always true. If you have medical expenses, disability-related costs, or support from family members, those can be excluded. For example, if your child sends you $500 a month to help with bills, that doesn’t count as income for Extra Help.

Also, if you live in Alaska or Hawaii, the income limits are higher - $26,445 for singles and $35,700 for couples. If you’re close to the limit, call Social Security. They’ll walk you through what counts and what doesn’t. Don’t assume you’re ineligible - get it checked.

Why So Many Seniors Miss Out

The Government Accountability Office found that 4.3 million eligible seniors aren’t enrolled in Extra Help. That’s a $26.8 billion gap in assistance. Why?

Many think they make too much. Others don’t know the program exists. Some are afraid of the application. A few don’t trust the government. But the truth is, the system is designed to help you - not punish you.

The biggest mistake? Not applying because you think you’re ineligible. In 2025, Social Security started an automated screening tool on their website. It asks you a few questions and tells you if you likely qualify. It takes under 5 minutes. Go to ssa.gov/extrahelp and click “Check Your Eligibility.”

What Happens After You Apply?

If you’re approved, you’ll get a letter from Social Security. That’s your official notice. Then, if you’re not already in a Part D plan, they’ll enroll you in one - usually the lowest-cost plan in your area with $0 premium. You’ll get your new card in the mail within 2 to 3 weeks.

Your pharmacy will automatically apply your Extra Help benefits at checkout. You won’t need to show extra paperwork. Just present your Medicare card and your prescription. The discount is built in.

If you’re already in a Part D plan, your premiums and copays will drop automatically. You don’t have to switch plans unless you want to. You can keep your current one - and just pay less.

Senior receiving medication at pharmacy with dollar-saving icons floating around them.

What to Do If You’re Denied

If you’re denied, you have 60 days to appeal. The letter you get will explain why. Common reasons: income was counted wrong, resources were overstated, or documents were missing.

Call Social Security. Ask them to review your case. Bring your tax return, bank statements, and a list of all your income sources. Sometimes, just one correction - like excluding your child’s military allowance - flips the decision.

You can also get free help from your State Health Insurance Assistance Program (SHIP). They’re trained counselors who help seniors with Medicare questions. Find yours at shiptacenter.org.

Extra Help Isn’t Just for Seniors - It’s for Everyone Who Needs It

This isn’t a handout. It’s a safety net. Millions of seniors take medications for diabetes, heart disease, arthritis, and high blood pressure. Without Extra Help, they skip doses, split pills, or go without. That leads to hospital visits - which cost far more than the program.

The Inflation Reduction Act didn’t just make Extra Help bigger - it made it smarter. It removed confusion. It stopped people from getting half the help they deserved. And it ensured that no one has to choose between food and medicine.

If you’re over 65, on Medicare, and your medications are a burden - apply. Even if you think you don’t qualify. Even if you’ve been told no before. The rules changed. The system is better now. And your health is worth it.

Need Help Applying?

You don’t have to do this alone.

  • Call Social Security: 1-800-772-1213 (TTY 1-800-325-0778)
  • Go to ssa.gov/extrahelp - use the online screening tool
  • Visit your local Social Security office - no appointment needed
  • Ask your pharmacist - many have outreach staff who help with applications
  • Contact your State Health Insurance Assistance Program (SHIP) - free, local help

It’s not a complicated process. It’s not a bureaucratic nightmare. It’s a lifeline - and it’s waiting for you.

Do I have to reapply for Extra Help every year?

No. Once you’re approved, your Extra Help status is reviewed automatically each year. If your income or resources change significantly, Social Security will contact you. Otherwise, you keep your benefits without doing anything.

Can I still get Extra Help if I have other insurance?

Yes. Extra Help works alongside other coverage like VA benefits, TRICARE, or employer plans. You can still enroll, and Extra Help will reduce your out-of-pocket costs for prescriptions not covered by your other plan.

What if I’m on Medicaid? Do I still need to apply?

No. If you’re on Medicaid, you’re automatically enrolled in Extra Help. You’ll get a letter from Social Security confirming this. You don’t need to do anything else.

Can I switch my Medicare Part D plan after getting Extra Help?

Yes. You can change your Part D plan once a year during the Annual Enrollment Period (October 15 to December 7). But if your meds change or your plan stops covering them, you can switch outside that window. Extra Help gives you more flexibility than most beneficiaries.

Does Extra Help cover over-the-counter medications?

No. Extra Help only applies to prescription drugs covered under Medicare Part D. Over-the-counter medicines like pain relievers or allergy pills aren’t included. But some Medicare Advantage plans offer extra OTC benefits - check your plan’s details.