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Medicare prescription help
Last updated: 20 September 2026
If Medicare prescription costs are hard to afford, start with Extra Help. It can cut Part D premiums, deductibles, and copays for people with limited income and resources. Other programs can help when Extra Help is not enough or does not fit.
Bottom Line
Start with Extra Help, not a payment plan. In 2026, Medicare lists Extra Help income limits of $23,940 for one person and $32,460 for a married couple in the 48 states and Washington, D.C. The public resource limits are $18,090 and $36,100. If you qualify, many people pay a $0 deductible and no more than $5.10 for a generic drug or $12.65 for a brand-name drug at a participating pharmacy. Check the current rules on Medicare Extra Help and apply through Social Security.
Need Medicine Right Now?
If you may run out in the next few days, call your drug plan first and say how many doses you have left. You can also call Medicare at 1-800-633-4227; TTY users can call 1-877-486-2048.
If you qualify for Extra Help or Medicaid but are not yet enrolled in a Part D plan, ask about LI NET temporary coverage. LI NET can provide temporary Part D coverage while regular enrollment catches up. Keep pharmacy receipts if you paid out of pocket.
Start Here
- Check automatic eligibility. If you have full Medicaid, Supplemental Security Income (SSI), or a Medicare Savings Program, you usually get Extra Help automatically.
- Apply if you are unsure. You can apply for Extra Help at any time. You do not have to wait for Medicare Open Enrollment.
- Compare your actual drugs. Use Medicare Plan Compare with your drug names, doses, and pharmacy. A low premium does not always mean the lowest total drug cost.
| Your situation | Best first step | What to ask |
|---|---|---|
| You have Medicaid, SSI, or an MSP | Check automatic Extra Help | “Is my Extra Help active, and what should I pay at the pharmacy?” |
| You do not know if you qualify | Apply through Social Security | “Can my information also go to my state for an MSP application?” |
| Part B premiums are also hard to afford | Check Medicare Savings Programs | “Could I qualify for QMB, SLMB, or QI?” |
| Your pharmacy charge looks wrong | Call the plan and Medicare | “Please verify my subsidy level before I run out of medicine.” |
What Has Changed
- A new Medicare GLP-1 Bridge began July 1, 2026. Certain people with Part D can get covered weight-management GLP-1 drugs through this temporary program for a $50 monthly copay if they meet Medicare’s rules and their provider completes prior authorization. Extra Help does not reduce that $50 copay. See Medicare GLP-1 Bridge.
- The 2026 Extra Help limits remain in effect. Medicare’s public page lists $23,940/$32,460 for income and $18,090/$36,100 for resources. CMS explains that the public resource figures include up to $1,500 per person for burial expenses; without that exclusion, the underlying resource limits are $16,590/$33,100. See the 2026 LIS limits.
- The 2026 Part D out-of-pocket limit is $2,100. After the Part D out-of-pocket threshold is reached for covered Part D drugs, cost sharing is $0 for the rest of the calendar year. See 2026 Part D costs.
Extra Help Rules for 2026
Extra Help is the Medicare Part D Low-Income Subsidy. It helps with prescription drug plan premiums, deductibles, and cost sharing. It also removes the Part D late enrollment penalty while you receive Extra Help.
You usually qualify automatically if you have full Medicaid, receive SSI, or your state pays your Part B premium through a Medicare Savings Program. If none of those apply, Social Security can decide whether your countable income and resources fit the 2026 limits.
| Rule | One person | Married couple |
|---|---|---|
| Public annual income limit* | $23,940 | $32,460 |
| Public resource limit** | $18,090 | $36,100 |
| Generic copay maximum | Up to $5.10 | Up to $5.10 |
| Brand-name copay maximum | Up to $12.65 | Up to $12.65 |
*These income figures apply to the 48 contiguous states and Washington, D.C. Alaska and Hawaii have higher limits, and household size matters. Social Security uses countable income, so do not self-deny based only on gross income. **The public resource figures include the burial-expense exclusion described above.
What Extra Help can lower
For qualifying people, the Part D deductible is $0 and covered prescriptions at participating pharmacies are generally limited to the copays above. Some full-benefit Medicaid beneficiaries pay even less. If you have full Medicaid and very low income, your 2026 copays can be as low as $1.60 for generic drugs and $4.90 for brand-name drugs.
A $0 premium is common when you are in a plan at or below the Extra Help benchmark. If you chose a plan whose premium is above the benchmark, you may still owe the difference. CMS explains this issue in its Extra Help notices.
Who should still apply
Do not assume you are over the limit because of one bank balance or your gross Social Security amount. Some resources are excluded, including your primary home and personal possessions, and Social Security applies income exclusions. If your finances changed recently, you can reapply at any time.
If you also struggle with Part B costs, check our Medicare Savings Programs guide. QMB, SLMB, and QI can trigger automatic Extra Help and may reduce other Medicare costs too.
Other Prescription Drug Help to Check
| Program | Best for | Main limit |
|---|---|---|
| Medicare Savings Programs | People who also need help with Part A or Part B costs | State rules and financial limits apply |
| LI NET | People with Extra Help or Medicaid who lack active Part D coverage | Temporary bridge, not long-term coverage |
| State drug programs | People who meet a state’s age, income, disability, or residency rules | Not every state has one |
| Manufacturer assistance | Certain expensive medicines with company programs | Rules differ by drug and company |
| Payment Plan | Spreading large Part D costs across months | Does not lower the total price |
| GLP-1 Bridge | Certain Part D enrollees using eligible GLP-1s for weight management | Clinical rules, prior authorization, $50 copay |
Medicare Savings Programs
QMB, SLMB, and QI are state-run programs. In 2026, the federal QMB monthly income limit is $1,350 for one person and $1,824 for a married couple; SLMB is $1,616/$2,184; QI is $1,816/$2,455. States can use more generous rules. Check the current Medicare Savings limits and apply through your state Medicaid office.
LI NET
LI NET is for a narrow but urgent problem: you qualify for Extra Help or Medicaid, but your regular Part D coverage is not active yet. It can cover Part D drugs at the pharmacy counter and may provide some retroactive coverage. Keep receipts. If you are stuck, call LI NET at 1-800-783-1307; TTY users can call 711.
State and manufacturer programs
Some states have State Pharmaceutical Assistance Programs (SPAPs), and some drug manufacturers have Patient Assistance Programs. Medicare’s prescription help tools can help you check both. Manufacturer programs are drug-specific, and eligibility can change, so verify the program directly before relying on it.
Medicare Prescription Payment Plan
This option can spread covered Part D out-of-pocket costs across the remaining months of the year. It does not reduce what the drugs cost. Medicare’s Payment Plan page explains how it works. Our Payment Plan guide can help you decide whether spreading the bill would actually help your budget.
Medicare GLP-1 Bridge
This temporary program began July 1, 2026. It covers certain GLP-1 medicines for weight management for people who meet Medicare’s clinical rules and have an eligible Part D plan. Your provider must complete prior authorization when required. The copay is $50 for a one-month supply. That $50 does not count toward the Part D deductible or $2,100 out-of-pocket limit, and Extra Help does not lower it.
How to Apply Without Wasting Time
- Check whether you are already deemed eligible. Look for Medicaid, SSI, or Medicare Savings Program notices before starting a new Extra Help application.
- Apply through Social Security. Use the online Extra Help application or call 1-800-772-1213. TTY users can call 1-800-325-0778.
- Let SSA send your information to the state. Social Security can send information from your Extra Help application to your state to start an MSP application unless you tell SSA not to.
- Compare plans using your real medicines. Enter drug name, dose, frequency, and pharmacy. If a plan does not cover a drug well, our step therapy guide explains common coverage barriers and next steps.
- Get free counseling if needed. State Health Insurance Assistance Programs provide free Medicare counseling. Use the SHIP locator. Our SHIP and SMP guide explains what counselors can help with.
What to Gather Before You Apply
- Your Medicare card or Medicare number.
- Your Social Security number and, if applicable, your spouse’s information.
- Recent bank statements and tax returns.
- IRA, 401(k), pension, annuity, Veterans’ benefit, or Railroad Retirement statements.
- Your current medication list, doses, and preferred pharmacies.
- Medicaid, SSI, or MSP notices if you already receive one of those benefits.
- Pharmacy receipts if you paid out of pocket while coverage was delayed.
Helpful tip: Keep one folder with approval letters, plan notices, denial letters, and pharmacy receipts. It makes billing corrections and appeals much easier.
State Prescription Programs Can Add More Help
Federal Extra Help is national, but state prescription programs vary widely. Examples include:
- New York: EPIC 2026 is available to eligible residents age 65 or older with annual income up to $75,000 if single or $100,000 if married. Members must have Medicare Part D to receive EPIC benefits.
- New Jersey: PAAD may help residents age 65 or older, and certain adults with disabilities. The 2026 income limit is less than $54,943 if single or less than $62,390 if married.
- Pennsylvania: PACE and PACENET help eligible residents age 65 or older. The published income limits are $14,500 or less for single PACE applicants and up to $33,500 for single PACENET applicants, with separate married-couple limits.
If your state is not listed, use the Medicare state-program finder or ask SHIP. Do not assume that being over the federal Extra Help limit means there is no help.
Reality Checks
- Extra Help does not make every drug free. Formularies, pharmacy networks, prior authorization, and plan rules still matter.
- A $0 premium has a limit. If you choose a plan above the Extra Help benchmark, you may owe the amount above the subsidy.
- Discount-card purchases may not count toward Part D costs. A cash price can sometimes be lower, but a purchase made outside your Medicare plan generally does not count toward your Part D deductible or out-of-pocket maximum.
- The $2,100 cap applies to covered Part D spending. Our Part D cap guide explains what counts and what does not.
- Dual coverage can be confusing. If you have both Medicare and Medicaid, our dual eligible guide explains how the programs fit together.
Common Mistakes to Avoid
- Waiting for fall to apply: Extra Help applications are accepted year-round.
- Choosing a plan by premium only: Check the formulary and pharmacy network for every important medicine.
- Throwing away Medicare letters: Notices can prove your subsidy level and explain plan reassignment or premium changes.
- Missing a QI renewal: QI must be renewed every year, and states approve it on a first-come, first-served basis.
- Using the Payment Plan as “assistance”: It changes timing, not total cost.
Denied, Delayed, or Paying the Wrong Amount
If Social Security denies Extra Help and you think the decision is wrong, read the notice first. You generally have 60 days after receiving the notice to appeal. Social Security uses Form SSA-1021 for an Extra Help appeal.
If your state denies a Medicare Savings Program, ask the Medicaid office for the exact reason and appeal deadline. A missing bank statement or incorrect household information may be fixable without starting over.
If your Part D plan will not cover a drug, ask whether you or your prescriber can request a formulary exception or appeal. Medicare explains Part D appeals. If you need broader medical-cost help, our Medicaid for seniors guide explains another possible path.
If your pharmacy is charging too much even though Extra Help is active, contact the plan and tell it how many doses you have left. Medicare says the plan may ask for proof of Extra Help so it can correct your cost.
Backup Options if Extra Help Does Not Fit
Start with state assistance and manufacturer programs. Then ask your prescriber whether a lower-cost covered medicine is medically appropriate. If the problem is a single expensive fill rather than total yearly cost, a payment plan may help with cash flow.
For a broader list of savings routes, see our prescription cost help guide. Do not stop a medicine or change a dose because of price without speaking with your prescriber or pharmacist.
If you receive Medicaid or Extra Help, you may be able to change drug coverage once per calendar month. Medicare explains the current Special Enrollment Period. A plan change usually takes effect on the first day of the next month.
Phone Scripts You Can Use
Calling Social Security
“I have Medicare and need help paying for prescriptions. I want to apply for Extra Help. What information should I have ready, and can my information also be sent to my state for a Medicare Savings Program?”
Calling your drug plan
“I have Extra Help, but the pharmacy charged more than I expected. I have _____ days of medicine left. Please verify my subsidy level and tell me what the pharmacy should charge.”
Calling SHIP
“I need free help comparing Part D plans and checking Extra Help or Medicare Savings Programs. I have my drug list and pharmacy information. Can a counselor review my options?”
Calling a state program
“My Medicare drug costs are still high. Does my state have a prescription assistance program, and what income or residency documents should I prepare before I apply?”
Resumen en español
Si tiene Medicare y sus medicamentos cuestan demasiado, primero revise Extra Help. En 2026, los límites públicos de ingresos son $23,940 para una persona y $32,460 para una pareja casada en los 48 estados y Washington, D.C. Los límites son más altos en Alaska y Hawái.
Si recibe Medicaid completo, SSI o un Medicare Savings Program, normalmente recibe Extra Help automáticamente. Si no está seguro, puede solicitarlo con Seguro Social al 1-800-772-1213. También puede pedir ayuda gratuita a SHIP.
Si necesita una medicina ahora y todavía no tiene cobertura activa de la Parte D, pregunte por LI NET. Si su estado tiene un programa de medicamentos o el fabricante ofrece ayuda, esos programas también pueden reducir algunos costos. El Medicare Prescription Payment Plan solamente reparte los pagos; no reduce el precio total.
Desde el 1 de julio de 2026, el programa temporal Medicare GLP-1 Bridge puede cubrir ciertos medicamentos GLP-1 para algunas personas con Parte D que cumplen reglas clínicas. El copago es $50 y Extra Help no reduce ese copago.
FAQ
What are the 2026 Extra Help income limits?
For the 48 contiguous states and Washington, D.C., Medicare lists $23,940 for one person and $32,460 for a married couple. Alaska and Hawaii have higher limits, and Social Security uses countable income rather than simply looking at gross income.
Do Medicaid or SSI recipients need to apply for Extra Help?
Usually no. People with full Medicaid, Supplemental Security Income, or a Medicare Savings Program generally qualify automatically. Keep the Medicare notice that confirms your Extra Help status.
Can I apply for Extra Help outside Medicare Open Enrollment?
Yes. You can apply for Extra Help at any time before or after you enroll in Part D. If your income or resources change, you can also reapply.
Why am I still paying a Part D premium with Extra Help?
Your plan may not have updated your subsidy yet, or you may have chosen a plan with a premium above the Extra Help benchmark. Call the plan and ask it to verify your subsidy level and the premium amount you are responsible for.
Does Extra Help lower the Medicare GLP-1 Bridge copay?
No. Medicare says the GLP-1 Bridge has a $50 copay for a one-month supply and Extra Help does not reduce that copay. The $50 also does not count toward your Part D deductible or out-of-pocket limit.
What can I try if I do not qualify for Extra Help?
Check a State Pharmaceutical Assistance Program, manufacturer patient assistance, lower-cost covered alternatives, and whether another Part D plan fits your drug list better. Also ask your state whether its Medicare Savings Program rules are more generous than the federal minimums.
About This Guide
Sources: This guide uses official federal, state, local, and other high-trust nonprofit and community sources linked in the article.
Editorial note
This guide is produced under the GFS Editorial Standards using official and other high-trust sources. GFS is not affiliated with a government agency and is not a substitute for official agency guidance. Individual eligibility outcomes cannot be guaranteed.
Corrections
Despite careful verification, errors may occur. Readers may email info@grantsforseniors.org with corrections.
Disclaimer
This article is for informational purposes only and is not legal, financial, medical, tax, disability-rights, immigration, or government-agency advice. Program rules, policies, funding, coverage, and availability can change. Readers should confirm current details directly with the responsible official program before acting.
Last updated: 20 September 2026 · Next review: 20 January 2027
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