Medicare Prescription Help 2026: Extra Help Income Limits

If you have Medicare and your prescriptions cost more than you can comfortably pay, there is a federal program that can take your drug plan premium and deductible to $0 and cap what you pay at the pharmacy counter at $5.10 for a generic and $12.65 for a brand-name drug. It is called Extra Help, and it is run by Social Security — not by your state, and not by your drug plan.

The most common reason people miss it is a mix-up about who qualifies. Extra Help is not only for people on Medicaid. In 2026 an individual can earn up to $23,940 a year and still qualify — noticeably more than the Medicare Savings Programs allow.

What Extra Help Pays in 2026

These are the 2026 figures published by Medicare.gov:

Your Part D cost (2026)	With Extra Help
Monthly plan premium	$0
Yearly deductible	$0
Each generic drug	up to $5.10
Each brand-name drug	up to $12.65
After your total drug costs reach $2,100	$0 for each covered drug
Part D late enrollment penalty	not charged while you get Extra Help

Two adjustments to that table are worth knowing:

• If you have full Medicaid coverage and are in the QMB program, Medicare states you pay no more than $4.90 for each covered drug. CMS’s cost-sharing table for 2026 puts that group at $1.60 for a generic and $4.90 for a brand-name drug.
• If you have full Medicaid and live in an institution or get home- and community-based services, CMS lists your 2026 copayment as $0.

The prices above apply at pharmacies that are in your plan’s network.

Who Gets Extra Help Without Applying

Medicare states you qualify automatically — no application — if you get any one of these:

• Full-benefit Medicaid coverage
• Help from your state paying your Part B premiums, such as through a Medicare Savings Program
• Supplemental Security Income (SSI) payments from Social Security

If that is you, a notice arrives in the mail telling you what you will pay, and Medicare enrolls you in a drug plan if you do not already have one. You can switch to a different plan if the one you are assigned does not cover your drugs.

Everyone else has to apply — and that is the group this guide is really for.

The 2026 Income and Resource Limits

48 contiguous states and DC

Your situation	Income limit	Resource limit
Individual	$23,940	$18,090
Married couple	$32,460	$36,100

Alaska

Your situation	Income limit	Resource limit
Individual	$29,925	$18,090
Married couple	$40,575	$36,100

Hawaii

Your situation	Income limit	Resource limit
Individual	$27,540	$18,090
Married couple	$37,335	$36,100

The income limits are 150% of the 2026 federal poverty guidelines — for the 48 states, 150% of $15,960 for one person and of $21,640 for two. That is why they change every January.

The resource number has two versions, and most pages only show one

This trips people up, so it is worth being precise. CMS’s 2026 guidance sets the resource limit at $16,590 ($33,100 if married). If you tell Social Security on the application that you expect to use some of your resources for burial expenses, the limit becomes $18,090 ($36,100 if married) — the extra $1,500 per person is the burial set-aside.

Medicare.gov publishes the $18,090 / $36,100 version. So if you have counted your savings against $18,090, be aware the lower figure is what applies unless the burial question is answered. Either way, the practical advice is the same: apply and let Social Security do the arithmetic.

What actually counts

Plenty of what people assume will disqualify them does not count at all.

Not counted as a resource: your home, one car, household and personal items, furniture, a burial plot, and up to $1,500 set aside for burial expenses.

Counted as a resource: cash, money in checking, savings or retirement accounts, stocks, bonds, savings bonds, mutual funds, and real estate other than the home you live in.

Not counted as income: SNAP, housing assistance, home energy assistance (such as LIHEAP), scholarships and education grants, disaster assistance, earned income tax credit payments, victim compensation payments, medical treatment and drugs, and help from others with household expenses.

Counted as income: wages, self-employment earnings, Social Security benefits, pensions, annuities, Railroad Retirement Board benefits, veterans benefits, rental income, alimony, and workers’ compensation.

One more rule that matters for couples: if you are married and living with your spouse, both incomes and resources count even if only one of you applies. If you are married and not living together, only yours count.

Extra Help and Medicare Savings Programs Are Not the Same Test

This is the single most useful thing to know if you have been turned down before.

	Extra Help (2026)	Medicare Savings Programs (2026, most generous tier)
What it pays	Part D drug costs	Part B premium, and more at the QMB level
Who runs it	Social Security	Your state
Income limit, individual	$23,940 a year	$1,816 a month (QI) ≈ $21,792 a year
Resource limit, individual	$16,590 ($18,090 with burial funds)	$9,950

The resource limit is where the gap is widest — Extra Help allows roughly $6,600 more in savings than QMB, SLMB, or QI do. A denial from your state’s Medicare Savings Program does not mean Social Security will deny Extra Help.

It also runs the other way, and in your favor: when you file the Extra Help application, Social Security sends the information to your state to start a Medicare Savings Program application unless you tell them not to on the form. One application, two programs considered.

How to Apply

1. Apply through Social Security. Go to SSA.gov/extrahelp and file online, or call 1-800-772-1213 (TTY 1-800-325-0778) to set up an appointment. Phone appointments are available in most U.S. time zones Monday through Friday, 8 a.m. to 7 p.m., in English, Spanish, and other languages.
2. Apply whenever — the timing is flexible. Social Security states you can apply for Extra Help any time before or after you enroll in Part D. You do not have to wait for open enrollment.
3. Have your financial information ready. The application asks about your income and your resources — bank balances, investments, and any real estate besides your home.
4. Leave the Medicare Savings Program box alone unless you have a reason not to, so your state also considers you for Part B premium help.
5. Get free help if you want it. Your State Health Insurance Assistance Program (SHIP) gives free one-on-one counseling, including help filling out this application. You can also call 1-800-MEDICARE (1-800-633-4227), TTY 1-877-486-2048.

Once you qualify, you keep Extra Help through December 31 of that year even if your income goes up mid-year, and your eligibility is reviewed for the following year automatically.

If You Are Denied — or If You Already Paid Too Much

If you are denied, you have 60 days to appeal, counted from the day after you receive Social Security’s letter. The form is SSA-1021, available at SSA.gov/forms. Social Security gives you a hearing by phone unless you choose a case review, and someone not involved in the first decision handles it. You can also simply reapply at any time if your income or resources change.

If you qualified but were not in a drug plan yet and paid out of pocket, Medicare’s Limited Income Newly Eligible Transition (LI NET) program may refund part of what you paid. Keep your receipts and call 1-800-783-1307 (TTY 711).

If you think you are being charged the wrong amount, contact your drug plan first — your plan may ask for proof, and the purple, yellow, green, or orange notices Medicare mails you are accepted as proof. If that does not resolve it, call 1-800-MEDICARE.

Two Limits to Know Before You Start

• Extra Help is not available in Puerto Rico, the U.S. Virgin Islands, Guam, the Northern Mariana Islands, or American Samoa. Medicare states other programs exist in those areas and directs you to your State Medical Assistance (Medicaid) office.
• If you have retiree drug coverage from a former employer or union, joining a Medicare drug plan may end that coverage for you and your dependents, even if you qualify for Extra Help. Call your employer’s benefits administrator before you enroll.

There Is No Fee, Ever

Applying for Extra Help is free. Social Security does not charge for it, no one has to file it on your behalf, and SHIP counseling is free too. Anyone who asks you to pay to apply — or who phones asking for your Medicare number to “check if you qualify” — is not part of this program. Hang up and apply yourself.

Related Guides

• Medicare Savings Programs cover the other half of the picture — your $202.90 Part B premium — and one Extra Help application can start that process too.
• If your drug costs stay high, NeedyMeds and the HealthWell Foundation cover gaps Extra Help does not.
• Medicaid is the route that makes Extra Help automatic — worth checking first if you may qualify.
• For care itself, community health centers charge on a sliding scale based on income.
• Many people on a fixed income who qualify here also qualify for the Lifeline phone and internet discount and Meals on Wheels.

How We Checked This

Every figure on this page was read directly from a primary source. The 2026 income limits, the $0 premium and deductible, the $5.10 and $12.65 pharmacy caps and the $2,100 threshold come from Medicare’s help-with-drug-costs page; the two different resource limits from CMS’s CY 2026 LIS resource memo; the application routes from SSA.

Where the consumer pages and the regulations could be read as disagreeing — the resource limit is published as $16,590 in one place and $18,090 in another — we explain above that both are correct and which question on the application decides it, rather than picking one number and hiding the other.

We also read Social Security’s internal staff manual, because two rules that matter here are not on any consumer page. POMS HI 03001.005 lists exactly who is “deemed” eligible without applying — SSI recipients, people with full Medicaid, and QMB/SLMB/QI enrollees — and then notes that QDWI participants “are not deemed eligible for Extra Help.” And POMS HI 00815.024 states that an Extra Help application filed on or after January 1, 2010 “will start the application process for Medicare Savings Programs (MSP) benefits unless the beneficiary objects” — meaning this one form can reach a second program. Our side-by-side comparison covers both rules in full.

If Social Security tells you something different about your case, trust them for your case and tell us so we can re-check the guide.

Extra Help is a federal program administered by the Social Security Administration; the figures on this page are the 2026 federal amounts and do not vary by state except in Alaska and Hawaii, as shown. All figures were verified on Medicare.gov, SSA.gov, and CMS’s CY 2026 LIS guidance on August 11, 2026 and re-verified on Medicare.gov and SSA’s POMS on August 21, 2026.