KFF's 2025 analysis counted 13.1 million people with Extra Help in 2025. Yet the Medicare Rights Center once estimated nearly 3.5 million eligible people were not enrolled. This guide explains what LIS is, who qualifies in 2026, whether enrollment is automatic, how to apply through Social Security, and what to do after you get a decision.
Key Takeaways
- Extra Help lowers Part D premiums, deductibles, and copays for eligible people.
- Medicaid, SSI, or Medicare Savings Program enrollment can qualify you automatically.
- 2026 limits: $23,940 income for an individual, $32,460 for a couple.
- Everyone else applies through the Social Security Administration (SSA).
- Extra Help covers only Part D drugs your plan covers.
What Is Medicare Extra Help and How Does It Work?
Extra Help is a federal program that helps people with limited income and resources pay Part D costs. The Social Security Administration (SSA) reviews applications and sends decisions, and the Centers for Medicare & Medicaid Services (CMS) sets the cost-sharing rules plans must follow.
What Extra Help can reduce
- Premiums: a 100% subsidy, capped at the lesser of your plan's basic premium or your region's benchmark amount. California's 2026 benchmark is $12.00 a month and New York's is $58.82, so there is no single national figure.
- Deductible: $0 in 2026.
- Copays: up to $5.10 for generics and $12.65 for brand-name drugs for most recipients.
- After the $2,100 out-of-pocket threshold: $0 for covered Part D drugs.
Copay categories in 2026
Cost-sharing depends on your category, and Medicaid alone does not guarantee zero copays.
| Category | Generic | Brand |
|---|---|---|
| Full-benefit dual eligible, institutionalized or receiving home and community-based services | $0 | $0 |
| Full-benefit dual eligible, income at or below 100% of the federal poverty level (FPL) | $1.60 | $4.90 |
| Full-benefit dual eligible, income above 100% up to 150% FPL | $5.10 | $12.65 |
| Other full-LIS recipients | $5.10 | $12.65 |
Extra protections and limits
- You pay no Part D late-enrollment penalty while you receive Extra Help.
- Since January 1, 2025, you can use a special enrollment period once a month to move into Original Medicare with a stand-alone drug plan, or switch between stand-alone plans. Changes start the first day of the next month.
- That monthly option does not let you move freely between Medicare Advantage plans.
- Extra Help applies only to covered Part D drugs, so check your plan's formulary and pharmacy network.
Who Qualifies for LIS in 2026?
Basic requirements
- Medicare Part A, Part B, or both
- Residence in one of the 50 states or DC
- Not incarcerated
- Enrollment (or plans to enroll) in a Part D drug plan or Medicare Advantage plan with drug coverage in your service area
2026 income and resource limits
| Situation | Annual income | Resources (with burial allowance) | Resources (without burial) |
|---|---|---|---|
| Individual | $23,940 | $18,090 | $16,590 |
| Married couple living together | $32,460 | $36,100 | $33,100 |
Income figures are annual, not monthly. The higher resource limits apply if you tell SSA you expect to use resources for burial expenses. Working, supporting family members in your household, or living in Alaska or Hawaii can raise the income limit that applies to you.
What counts and what doesn't
- Counts as income: Social Security, pensions, Railroad Retirement, Veterans benefits, wages, net rent, alimony
- Doesn't count as income: SNAP, housing and home-energy help, disaster assistance, scholarships
- Counts as resources: bank accounts, stocks, bonds, mutual funds, IRAs, real estate other than your home
- Doesn't count as resources: your primary residence, vehicles, personal possessions, life insurance, burial plots
Automatic eligibility
You qualify automatically if you have full Medicaid, SSI, or a Medicare Savings Program (MSP) paying your Part B premium. Look for a purple notice from Medicare or SSA. If you have one, you don't need a separate application.
How LIS differs from MSPs and IRMAA
LIS (Extra Help) lowers Part D prescription drug costs. QMB, SLMB, and QI are separate Medicare Savings Programs that pay certain Medicare costs under state-administered rules.
IRMAA is a higher-income surcharge added to premiums. It is not assistance, and it is not the Extra Help application.
How to Apply for LIS: A Step-by-Step Guide
1. Confirm whether you need to apply
Check whether you already get Medicaid, SSI, or MSP help, or received a purple notice. If not, apply, even if you're unsure you're under the limits. SSA makes the call.
2. Gather your information
- Your and your spouse's Social Security numbers and names as printed on the cards
- Bank, investment, and cash balances
- Other real estate you own
- Income sources, including wages and self-employment earnings
- Relatives you support
The paper form tells you not to attach documents. SSA matches its own records, and may ask for bank or investment statements only if something doesn't line up.
3. Submit through an official channel
| Method | Details |
|---|---|
| Online | ssa.gov/medicare/part-d-extra-help |
| Phone | 1-800-772-1213 (TTY 1-800-325-0778) |
| Paper | Form SSA-1020 |
| In person | Your local SSA office, found at ssa.gov/locator |
Applying does not enroll you in a drug plan. You still need a Part D plan or a Medicare Advantage plan with drug coverage.
4. Review before you submit
Check household status, income, resources, contact details, and Medicare information. Inconsistent answers slow decisions. Save a confirmation and note the date.
5. Track the decision
SSA's current guidance gives no fixed processing time (the 60 days you may see refers to appeals). Call the number above or visit a local office if you're waiting. When your notice arrives, check:
- The effective date
- Your eligibility category and cost-sharing level
- Any instructions about choosing or changing a drug plan
What Happens After You Apply for Extra Help?
After approval
Confirm your plan or pharmacy shows the benefit and the right effective date. Then compare plans for formulary coverage, pharmacy access, and costs. Extra Help doesn't pick a plan for you.
Your eligibility is reviewed annually. If SSA selects you, return the review form within 30 days, or assistance can stop the following year.
If you qualify but have no drug plan yet, the Limited Income Newly Eligible Transition (LI NET) program offers temporary coverage. Call 1-800-783-1307.
If costs look wrong
- Ask your pharmacist or plan to review the claim.
- Give the plan proof of your status, such as a purple, yellow, green, or orange Medicare notice or an SSI award letter. CMS requires plans to correct cost sharing when this evidence shows the subsidy is wrong.
- Call 1-800-MEDICARE (1-800-633-4227) if the record still looks wrong.
- Keep receipts and notices.
If you're denied or the benefit is lower than expected
Read the notice and find the reason. You have 60 days from receipt to appeal, and receipt is presumed five days after the notice date. Use form SSA-1021 or call SSA. Review is usually by phone or on the written record; a hearing isn't required.
File the appeal rather than a new application. A new application can lose subsidy months an appeal would preserve. You may also reapply any time your income, resources, or household changes. Your State Health Insurance Assistance Program (SHIP) can help.
Other Medicare Savings Help and Where to Get Guidance
Medicare Savings Programs at a glance
| Program | What it pays | Monthly income limit (individual / couple) |
|---|---|---|
| QMB | Part A premium if applicable, Part B premium, deductibles, coinsurance, copays | $1,350 / $1,824 |
| SLMB | Part B premium | $1,616 / $2,184 |
| QI | Part B premium | $1,816 / $2,455 |
These are Medicare.gov's 2026 figures. States vary, and some allow higher income or resources. QI requires yearly reapplication and is first-come, first-served.
Who to call
- SSA (1-800-772-1213): the Extra Help application and decision
- Medicare (1-800-MEDICARE): coverage questions and status checks
- SHIP (877-839-2675, shiphelp.org): free, unbiased counseling
- A licensed agent: plan comparisons
In Virginia or West Virginia, Muneris Benefits' licensed agents, including Baylee Davis, help people moving into Medicare understand and compare plans. Muneris Benefits has done this since 1990. Social Security, not Muneris Benefits, decides Extra Help eligibility and processes the application.
Frequently Asked Questions
How do I apply for LIS (Medicare Low-Income Subsidy)?
Apply with SSA online, by phone at 1-800-772-1213, or on paper with form SSA-1020. If you have Medicaid, SSI, or an MSP, you may already qualify automatically.
What are the income and resource limits for Extra Help in 2026?
Annual income must be under $23,940 (individual) or $32,460 (couple). Resources must be under $16,590 or $33,100, rising to $18,090 or $36,100 with a burial allowance. Some income and resources are excluded.
Which LIS category has $0 generic and $0 brand copays?
In 2026, full-benefit dual eligibles who are institutionalized or receive qualifying home and community-based services pay $0. Everyone also pays $0 after the $2,100 out-of-pocket threshold.
What is LIS and how does it work?
LIS, or Extra Help, is a Part D subsidy. It lowers premiums, deductibles, and copays for covered drugs when you meet the income and resource rules or qualify automatically.
What is SLMB and how does it differ from other savings programs?
SLMB is a Medicare Savings Program that pays your Part B premium. QMB also covers Medicare cost sharing, QI pays Part B premiums at a higher income limit, and LIS covers Part D costs.
Who is the best person to talk to about Medicare?
Use SSA for Extra Help applications, Medicare for official coverage questions, and SHIP for unbiased counseling. A licensed insurance professional can compare plans.
