Medicare Extra Help 2027: Who Qualifies, What It Pays, and How to Apply
By Rana — Editor, Elite Era Trends
If your prescription drug bill keeps climbing, a federal program is designed exactly for your situation — and millions who qualify have never applied. It is called Extra Help, worth about $5,700 a year on average according to Social Security. For 2027, it can cut your Part D costs to a $0 premium, a $0 deductible, and copays of just a few dollars per prescription.
The catch: the limits are strict, and the 2027 income limits are not yet published. This guide gives you the current 2026 limits, the 2026 and 2027 copays, three worked examples, and the three ways to apply — any time of year.
Contents
- Extra Help at a Glance: Limits and Copays
- What Is Medicare Extra Help?
- Who Qualifies for Extra Help in 2027?
- What Extra Help Pays
- Worked Examples: Do You Qualify, and What Would You Save?
- Extra Help vs Medicare Savings Programs
- What Extra Help Does Not Cover
- How to Apply for Extra Help
- Why Act Before December 7, 2026
- Frequently Asked Questions
- Sources
Extra Help at a Glance: Limits and Copays
Extra Help is Medicare’s Part D Low-Income Subsidy, run by Social Security. Pass two tests — income and resources — and it pays most of your drug-plan costs. Use the 2026 limits below: the 2027 income limits are not yet published, as HHS publishes the 2027 poverty guidelines in January.
2026 income and resource limits
| Limit | Single person | Married couple living together |
|---|---|---|
| Income limit (150% of the federal poverty level) | $23,940 a year ($1,995 a month) | $32,460 a year ($2,705 a month) |
| Resource limit | $16,590 | $33,100 |
| Resource limit with burial exclusion | $18,090 | $36,100 |
Income limits rest on the 2026 federal poverty level ($15,960 single, $21,640 couple), higher in Alaska and Hawaii. Tell Social Security money is set aside for burial and $1,500 per person is excluded — hence the $18,090 and $36,100 figures.
What Extra Help pays: 2026 vs 2027
| What it pays | 2026 | 2027 |
|---|---|---|
| Part D premium | $0, up to the regional benchmark | $0, up to the regional benchmark |
| Part D deductible | $0 | $0 |
| Generic copay | $5.10 | $5.80 |
| Brand-name copay | $12.65 | $14.40 |
| Lower copay rung (full Medicaid, income at or below 100% of poverty level) | $1.60 generic / $4.90 brand-name | $1.65 generic / $5.00 brand-name |
| Cost once total drug costs reach the out-of-pocket cap | $0 for covered drugs | $0 for covered drugs |
Standard Part D terms for 2027 (CMS Rate Announcement, 6 April 2026): $700 deductible, $2,400 out-of-pocket cap (up from $2,100 in 2026). Extra Help pays both in full.
What Is Medicare Extra Help?
Extra Help is the Low-Income Subsidy (LIS) for Medicare Part D — not a separate drug plan or a discount card, but a subsidy, administered by the Social Security Administration, that pays most of a Part D plan’s costs for people whose income and savings fall below set limits.
If you qualify, it pays your premium up to the regional benchmark, wipes out your deductible, and caps pharmacy copays. You pay no Part D late-enrollment penalty, and once total drug costs reach the $2,400 cap in 2027, you pay $0 for covered drugs.
Since January 2024, under the Inflation Reduction Act, everyone who qualifies gets the full subsidy; the old partial tier is gone. Extra Help also gives you a Special Enrollment Period, so you can switch Part D plans once per calendar quarter.
Who Qualifies for Extra Help in 2027?
You must pass two tests — income and resources — on the 2026 figures, since the 2027 income limits are not yet published.
The income test
Your income must be at or below 150% of the federal poverty level: $23,940 a year ($1,995 a month) single, $32,460 a year ($2,705 a month) for a married couple living together. Limits are higher in Alaska and Hawaii. Social Security counts most income, including your benefit itself — check it against the figure above; if it rose with the 2027 COLA, your 2027 Social Security COLA notice shows the new amount.
The resource test
Countable resources must be at or below $16,590 single, or $33,100 for a married couple living together. Money set aside for burial excludes $1,500 per person, lifting the limits to $18,090 and $36,100.
What counts? Bank accounts, stocks, bonds, mutual funds, and real estate other than your home. What does not count? Your home, one car, personal belongings, life insurance, and burial plots.
If you are close to the limit
A small amount over the line is not a definite no: apply anyway and let Social Security decide — the application is free, with no penalty for being turned down. If your income is just above the limit, check whether you qualify for a Medicare Savings Program instead: enrolment in one triggers automatic Extra Help, as explained below.
What Extra Help Pays
Your premium. Extra Help pays your Part D premium up to the regional benchmark — choose a plan at or below it and your premium is $0. That matters for 2027: KFF found on 30 October 2026 that stand-alone Part D enrollees who stay in their plan face an average premium rise from $34 to $51 a month. Our guide to the Part D premium increase for 2027 explains how to check whether your plan is above the benchmark.
Your deductible. Extra Help pays the full $700 Part D deductible for 2027. You pay nothing before your coverage starts.
Your copays. Copays are capped at $5.80 for generics and $14.40 for brand-name drugs in 2027 (up from $5.10 and $12.65 in 2026). With full Medicaid and income at or below 100% of the poverty level, the lower rung applies: $1.65 generics, $5.00 brand-name.
The out-of-pocket cap. Once total drug costs reach the $2,400 cap in 2027, you pay $0 for covered drugs for the rest of the year. No late-enrollment penalty applies, even if you signed up for Part D late.
Worked Examples: Do You Qualify, and What Would You Save?
Example 1: A single retiree on $1,800 a month
Margaret, 72, lives alone on a Social Security benefit of $1,800 a month, with $6,000 in savings. She owns her home and car.
- Income test: $1,800 × 12 = $21,600 a year, under the $23,940 single-person limit by $2,340 — she passes.
- Resource test: $6,000 in savings against a $16,590 limit; her home and car do not count. She is under by $10,590 — she passes.
- Result: Margaret qualifies for the full subsidy.
Example 2: The cost difference, with and without Extra Help
Take a typical stand-alone Part D plan at the average $51-a-month premium KFF reported for 2027 stayers.
Without Extra Help: premium $51 × 12 = $612 a year, plus the $700 deductible — $1,312 before a single copay.
With Extra Help: premium $0, deductible $0, and four generics a month at $5.80 — 4 × $5.80 = $23.20 a month, or $278.40 a year, about $278.
The premium and deductible alone save $1,312 a year; Social Security’s $5,700-a-year average reflects people with heavier drug needs.
Example 3: A married-couple check
James and Elaine, both on Medicare, live together on combined Social Security income of $2,500 a month, with $25,000 in savings and a small stock account. They own their home and one car.
- Income test: $2,500 × 12 = $30,000 a year, under the $32,460 married-couple limit by $2,460 — they pass.
- Resource test: $25,000 against a $33,100 limit — under by $8,100, so they pass; with burial money set aside, the limit would be $36,100.
- Result: They qualify, and both of them get the subsidy.
Extra Help vs Medicare Savings Programs
Both help people with limited income, and one can trigger the other — but they pay different things.
Extra Help pays your Part D prescription drug costs — premium, deductible, and copays. It is run by the Social Security Administration, and you apply to Social Security.
Medicare Savings Programs pay your Part B premiums — and, for the most generous tier, some deductibles and coinsurance. They are run by your state Medicaid office; you apply through your state. Our guide to Medicare Savings Programs for 2027 explains the QMB, SLMB, and QI tiers.
The link runs one way: enrolment in any Medicare Savings Program — QMB, SLMB, or QI — brings Extra Help automatically. The same applies with full Medicaid or Supplemental Security Income (SSI). So if you might qualify, applying through your state can unlock both benefits at once.
What Extra Help Does Not Cover
Extra Help does not pay your Part B premiums — that is what Medicare Savings Programs are for. It does not pay Medigap premiums, which belong to a separate private Medicare Supplement policy. And it does not pay for drugs outside your plan’s formulary: it pays your plan’s costs, but cannot force the plan to cover a drug it does not list. If a medicine you need is not on your formulary, ask your doctor about a formulary exception or a covered alternative — the quarterly Special Enrollment Period lets you switch plans if another covers your drugs better.
How to Apply for Extra Help
Apply any time of year, not just during open enrollment. Three ways:
- 1. Online. Apply at ssa.gov/medicare/part-d-extra-help using Form SSA-1020, the Application for Extra Help with Medicare Prescription Drug Plan Costs — the fastest route for most people.
- 2. By phone. Call Social Security at 1-800-772-1213 (TTY 1-800-325-0778), Monday to Friday, 8am to 7pm, and complete the application with a representative.
- 3. In person. Visit your local Social Security office. A list of your income and bank balances helps, but no documents are needed to submit the application — Social Security will follow up if it needs more information.
No fee, no penalty for being turned down. If approved, the subsidy usually starts the following month; if your circumstances change, apply again.
Why Act Before December 7, 2026
Open enrollment for 2027 coverage ends on December 7, 2026. If you are approved and choose a benchmark plan before then, your $0 premium starts on January 1, 2027. Apply later and you can still get Extra Help — applications are open all year — but your plan choice and start date follow the normal enrolment rules.
Apply for Extra Help now; while you wait, use our Medicare open enrollment checklist for 2027 to check whether your current Part D plan is at or below the benchmark and still covers your drugs. For the wider picture, see the Medicare 2027 hub.
Frequently Asked Questions
Medicare Extra Help is the federal Low-Income Subsidy that pays most of your Part D prescription drug costs if your income and savings are limited. It is run by the Social Security Administration, covers your plan premium up to a regional benchmark, and wipes out the deductible while capping your copays. It is a subsidy added to your Part D plan; since January 2024, everyone who qualifies receives the full subsidy.
You qualify for Extra Help in 2027 if you have Medicare Part D and your income is at or below $23,940 a year single, or $32,460 as a married couple, with savings and other resources under $16,590 single or $33,100 as a couple. The 2027 income limits are not yet published, so use the 2026 figures for now. Your home, one car, personal belongings, life insurance, and burial plots do not count, and limits are higher in Alaska and Hawaii.
Extra Help is worth about $5,700 a year on average, according to Social Security, because it pays your Part D premium up to the regional benchmark, removes the $700 deductible for 2027, and caps your copays at $5.80 for generics and $14.40 for brand-name drugs. Your exact saving depends on your plan and the medicines you take. Even a modest routine shows it: $51 a month plus the $700 deductible is $1,312 a year before a single copay, versus about $278 a year for four generics a month.
Apply for Extra Help online at ssa.gov/medicare/part-d-extra-help using Form SSA-1020, by phone at 1-800-772-1213, or in person at your local Social Security office. You can apply any time of year, you do not need documents to submit the form, and Social Security will contact you if it needs more information. There is no fee and no penalty for being turned down; if approved, the subsidy usually begins the following month.
You get Extra Help automatically, with no application, if you have full Medicaid, receive Supplemental Security Income, or are enrolled in any Medicare Savings Program, such as QMB, SLMB, or QI. Everyone else must apply, and you can do so any time of year, even outside open enrollment. If you might qualify for a Medicare Savings Program, apply through your state Medicaid office — approval triggers Extra Help automatically.
In 2027 the standard Part D deductible rises to $700 and the out-of-pocket cap rises to $2,400, but Extra Help still pays both in full, so qualifying beneficiaries see no deductible and no cap. Copays rise slightly to $5.80 for generics and $14.40 for brand-name drugs, and the 2027 income limits have not yet been published. Premiums are the other change: KFF found stayers face an average rise from $34 to $51 a month in 2027, so a benchmark plan chosen before December 7, 2026 locks in a $0 premium from January 1.
Sources
- Social Security Administration — Extra Help with Medicare Prescription Drug Plan Costs: ssa.gov/medicare/part-d-extra-help
- Centers for Medicare and Medicaid Services — CY 2027 Medicare Advantage and Part D Rate Announcement (6 April 2026)
- KFF — Part D premium analysis, 30 October 2026
- Medicare.gov — medicare.gov
Checked against SSA, Medicare.gov and CMS sources on 9 November 2026.
By Rana — Editor, Elite Era Trends
Rana is the editor of Elite Era Trends, where he explains Medicare, Social Security and AI news for US readers in plain language — costs, deadlines and plan choices, checked against official sources.
