Extra Help and the Part D low income subsidy are the same thing. Social Security calls it Extra Help in consumer materials, CMS calls it the LIS in plan guidance, and the phrase you hear depends on who is talking to you.
What it does is simple in a way most Medicare programs are not. It replaces your Part D cost structure with a much shorter one: no deductible, a covered premium, and two flat copay ceilings. Every figure below was pulled on September 6, 2026 from CMS, Medicare.gov and SSA’s POMS manual.
What Extra Help Actually Pays
Four separate pieces, and they stack.
The premium. Extra Help covers your Part D plan premium up to your region’s low income benchmark amount. Pick a plan priced at or under the benchmark and you pay $0. Pick a pricier plan and you pay the difference, which is the single most common way people with Extra Help end up with a premium bill anyway.
The deductible. Zero. CMS’s CY 2026 LIS cost-sharing table lists a $0 deductible for every subsidy category without exception.
The copays. Capped, and the cap depends on which category you fall into (table below).
The catastrophic phase. Once your out-of-pocket spending reaches the annual threshold, which is $2,100 for 2026, you pay $0 for covered drugs for the rest of the year. That $0 is not unique to Extra Help. Since 2024, section 11201 of the Inflation Reduction Act removed cost sharing above the threshold for every Part D enrollee. What Extra Help changes is how cheaply you get there.
NCOA, citing SSA, puts the average annual value of the whole package at about $5,700 per person.
The 2026 Copay Tiers
This is CMS’s official CY 2026 Maximum LIS Beneficiary Cost-Sharing Table, issued to Part D plan sponsors on October 31, 2025.
| Which category you fall into | Deductible | Generic copay | Brand copay |
|---|---|---|---|
| Full-benefit dual eligible, institutionalized or receiving home and community-based services | $0 | $0 | $0 |
| Full-benefit dual eligible, income at or below 100% of poverty | $0 | $1.60 | $4.90 |
| Full-benefit dual eligible, income between 100% and 150% of poverty | $0 | $5.10 | $12.65 |
| Deemed through a Medicare Savings Program (QMB, SLMB or QI) or through SSI | $0 | $5.10 | $12.65 |
| Applied and approved, income at or below 150% of poverty with resources within limits | $0 | $5.10 | $12.65 |
The $5.10 and $12.65 figures also appear on Medicare.gov’s drug costs page and in SSA POMS HI 03001.005, so they are confirmed on three federal sources. Those are ceilings, not prices. If a drug’s actual cost sharing would be less, you pay the lesser amount.
The 2026 Income and Resource Limits, and Where Sources Disagree
The income test is 150% of the federal poverty guideline. Medicare.gov publishes the 2026 cutoff as $23,940 for one person and $32,460 for a married couple, and those numbers line up exactly with the 150% column of SSA POMS HI 03001.020, the 2026 poverty table SSA’s own staff use, which shows $23,940 for a family of one and $32,460 for a family of two.
NCOA’s 2026 core benefits cheat sheet states the limit differently, as $2,015 a month for individuals and $2,725 for couples, because it adds the $20 monthly general income disregard on top of the 150% figure. Annualized that is about $24,180 and $32,700. Both are defensible. The disregard is real, and it means a few hundred dollars of income above the flat 150% line does not automatically disqualify you.
The resource test has a similar wrinkle, and this one is worth understanding because it changes who qualifies. CMS’s CY 2026 memo sets the base full-subsidy resource limit at $16,590 for one person and $33,100 for a married couple. But if you tell SSA you expect to use some of your resources for burial expenses, the limits rise by $1,500 per person, to $18,090 and $36,100. Those higher numbers are the ones Medicare.gov prints, with no explanation of the burial condition attached.
So the honest answer on resources is a range: $16,590 to $18,090 for one person and $33,100 to $36,100 for a couple, depending on whether you claim the burial exclusion. Counted resources include checking and savings accounts, stocks, bonds and other assets convertible to cash within 20 days, plus real estate that is not your primary home.
Alaska and Hawaii use higher poverty tables. POMS HI 03001.020 shows the 150% line for one person at $29,925 in Alaska and $27,540 in Hawaii.
Why the Handbook in Your Mailbox Says Something Different
If you are holding the printed Medicare & You 2026 handbook, its Extra Help table does not match anything above. On page 92 it lists yearly income under $23,475 for a single person and $31,725 for a married person, with resources under $17,600 and $35,130.
Read the sentence above the table. It says “below these limits in 2025.” Those are the prior year’s numbers, correctly labeled, sitting inside a book titled 2026. The handbook then tells you where to go: “You can find 2026 income and resource limits on Medicare.gov.”
This trips people up constantly, and it is worth knowing the tell. The limits are percentages of the HHS poverty guidelines, which reset every January, so any static document printed in the fall carries the outgoing year’s figures. If a page shows $23,475 or $17,600, it is a year behind. The current pair is $23,940 and $18,090.
The handbook also notes two limits nobody advertises: Extra Help is not available in Puerto Rico, the U.S. Virgin Islands, Guam, the Northern Mariana Islands or American Samoa, and Medicare Savings Programs are not available in Puerto Rico or the U.S. Virgin Islands.
The Inflation Reduction Act Killed the Partial Subsidy
Before 2024 there were two tiers. People up to 135% of poverty got the full subsidy. People between 135% and 150% got a partial subsidy with a sliding-scale premium, a deductible, and 15% coinsurance instead of flat copays.
Section 11404 of the Inflation Reduction Act of 2022 expanded full LIS eligibility to everyone up to 150% of poverty who meets the resource test, effective January 1, 2024. CMS’s LIS memo states the effect directly: beneficiaries who previously met the resource requirement for the partial LIS group are now eligible for the full benefit.
Practically, that added roughly the 135% to 150% band to the full subsidy. Anyone in that range moved from a partial benefit with real coinsurance to a $0 deductible and $5.10 or $12.65 copays.
Who Gets Extra Help Without Applying
Three groups are deemed eligible automatically, per SSA POMS HI 03001.005:
- People with full Medicaid coverage
- People enrolled in a Medicare Savings Program (QMB, SLMB or QI)
- People receiving Supplemental Security Income
Deemed status means no application, no interview and no proof of assets. It also means the MSP route is worth checking first if you are near the line, because getting into QMB, SLMB or QI hands you Extra Help as a side effect.
The exception is QDWI. POMS is explicit that Qualified Disabled Working Individuals are not deemed eligible, so a QDWI enrollee has to file for Extra Help separately.
How to Apply
Extra Help is a Social Security application, not a Medicare or plan application. Three ways in:
- Online at secure.ssa.gov/i1020, the Extra Help With Medicare Prescription Drug Plan Costs application.
- By phone at 1-800-772-1213 (TTY 1-800-325-0778), Monday through Friday.
- On paper, using form SSA-1020.
Filing does something else useful. Under MIPPA, an Extra Help application filed on or after January 1, 2010 also initiates a Medicare Savings Program application unless you decline. POMS HI 00815.024 describes the mechanism: data from your Extra Help determination is sent daily to your state Medicaid agency to begin the MSP application process. SSA does not decide the MSP outcome. Only the state does.
The Enrollment Window You Keep
People with Extra Help are not locked into the annual open enrollment calendar. Medicare.gov states that if you have Medicaid or get Extra Help, you may be able to change your drug coverage once per month.
That flexibility exists for a reason. Extra Help pays your premium only up to the regional benchmark, benchmark plans change from year to year, and a plan that cost you $0 in premium last year may not this year. The monthly window is your mechanism for moving back to a $0 plan without waiting until fall.
If You Are Just Over the Line
Extra Help is a hard cutoff at 150% of poverty plus the disregard. If you are above it, several other levers exist.
The Medicare Prescription Payment Plan does not lower your drug costs but spreads them across the calendar year at no interest, which solves a January cash-flow problem rather than a total-cost problem. Manufacturer and foundation programs, covered in our guide to prescription assistance programs, sit outside Medicare entirely. For generics, a cash price at Cost Plus Drugs or a discount card sometimes beats a Part D copay outright, though cash spending does not count toward your Part D out-of-pocket total.
If your income was high in a past tax year and has since dropped, the surcharge on your premiums may be appealable, which is what the IRMAA appeal guide covers. If you delayed Part D and are carrying a surcharge for it, note that Extra Help enrollees have that penalty waived, and the mechanics are in the late enrollment penalty guide. For hospital bills rather than drug bills, charity care is the parallel program.
Finally, the timing. The 2026 numbers above are the current published figures as of September 2026. CMS issues the following year’s LIS resource and cost-sharing limits in the fall, and the income limits move each January with the new poverty guidelines. Nothing labeled 2027 has been published yet.