Many seniors on Medicare pay far more than they should for everyday generic medications-sometimes $30, $50, or even $100 a month for pills that should cost less than a coffee. But if you have limited income, there’s a federal program called Medicare Extra Help that can cut those costs to just $4.90 per prescription. And in many cases, it’s free.
What Medicare Extra Help Actually Covers
Medicare Extra Help, also known as the Part D Low-Income Subsidy (LIS), is designed for people with low income and limited resources. It doesn’t just help with one part of your drug costs-it wipes out the entire burden. If you qualify, you pay $0 for your Medicare Part D plan premium. You pay $0 for the annual deductible. And for generic drugs, you pay no more than $4.90 per prescription at any participating pharmacy in 2025.
That’s not a discount. That’s a full subsidy. For someone taking four generic medications monthly, that’s about $235 a year instead of over $700. For someone on five or six prescriptions, the savings can exceed $1,000 annually.
There’s an even better tier: if you’re enrolled in both Medicare and Medicaid and your income is below 100% of the Federal Poverty Level ($16,590 for an individual in 2025), you pay only $1.60 per generic prescription. That’s less than the cost of a bus ticket.
Who Qualifies? Income and Resource Limits in 2025
To qualify for Extra Help, your income and resources must fall below strict federal limits. These aren’t suggestions-they’re hard cutoffs.
For 2025, the income limits are:
- Individual: $23,475 per year
- Married couple living together: $31,725 per year
This includes Social Security, pensions, wages, veterans benefits, and other regular income. But it doesn’t include housing assistance, food stamps, or medical payments.
Your resources-what you own-are also checked. These include bank accounts, stocks, bonds, mutual funds, and IRAs. Your primary home, one car, and personal belongings don’t count. Burial funds up to $1,500 per person are also excluded.
The resource limits are:
- Individual: $17,600
- Married couple: $35,130
If you’re just $500 over the income limit or $1,000 over the resource limit, you’re automatically disqualified. There’s no grace period. This is where many people get stuck.
Why Generic Drugs Are the Key to Saving Money
Extra Help doesn’t just lower your copays-it makes generics the most affordable option by design. Most Part D plans put generics in the lowest cost tier, and Extra Help locks that in at $4.90. Brand-name drugs cost $12.15 under Extra Help in 2025, so sticking with generics saves you even more.
Take a common blood pressure pill like lisinopril. Without Extra Help, it might cost $35 after your deductible. With Extra Help? $4.90. That’s an 86% drop. For diabetes meds like metformin or cholesterol drugs like atorvastatin, the savings are just as dramatic.
Doctors often prescribe brand names out of habit. But if you’re on Extra Help, ask your pharmacist or doctor: “Is there a generic version?” You’ll almost always get the same effectiveness at a fraction of the price.
How to Apply-And Avoid the Biggest Mistakes
You don’t need to be a Medicare expert to apply. The process is simple, but most people mess it up by waiting too long or skipping steps.
There are three ways to apply:
- Online at ssa.gov (the fastest method)
- By phone: Call 1-800-772-1213
- In person at your local Social Security office
If you already get Supplemental Security Income (SSI), Medicaid, or a Medicare Savings Program, you’re automatically enrolled. No paperwork needed.
But if you’re not automatically enrolled, here’s what most people get wrong:
- They assume they make too much money-then find out they qualify after filling out the form.
- They don’t list all income sources, like small pension payments or rental income.
- They forget to include joint bank accounts or assets held with a spouse.
It takes 3 to 6 weeks to get a decision. If you’re approved, your benefits start the month after you apply. If you’re denied, you can appeal. Don’t give up.
Free help is available through State Health Insurance Assistance Programs (SHIPs). They have counselors in every state who walk you through the form. Call 1-800-MEDICARE or visit medicare.gov to find your local SHIP.
The Annual Review Trap
Extra Help isn’t a one-time deal. Every year, starting in August, you’ll get a form in the mail asking you to update your income and resources. This is called the “renewal form.”
Here’s the catch: if you don’t return it by the deadline-usually within 30 days-you lose your Extra Help benefits on January 1 of the next year. No warning. No second chance.
Many people miss this because they think, “I didn’t get a raise, so nothing changed.” But even a small increase in Social Security, a one-time bonus, or selling an old car can push you over the limit. The system doesn’t care why-it only sees the number.
Set a calendar reminder for August 1 every year. Fill out the form as soon as you get it. If you’re unsure what to report, call SHIP or ask your pharmacist. They’ve seen this happen hundreds of times.
What Happens If You Lose Extra Help?
It’s devastating when you lose Extra Help. One man in California posted on Reddit: “I made $500 more than the limit because my Social Security went up. Now my $200-a-month generic meds cost me $1,200 a year in premiums plus $748 in copays. I had to choose between food and medicine.”
If you’re bumped off Extra Help, you still have options:
- Apply for a Medicare Savings Program (MSP) through your state. Some states have higher income limits.
- Switch to a Part D plan with a $0 premium and low copays for generics.
- Ask your pharmacy about manufacturer coupons or patient assistance programs.
- Use the $35 monthly insulin cap that started in 2025-this applies to everyone, even without Extra Help.
But none of these match the full protection of Extra Help. That’s why staying enrolled matters so much.
Real Stories: The Difference It Makes
A 78-year-old woman in Ohio was skipping her heart medication because it cost $45 a month. She applied for Extra Help after her church group told her about it. Within six weeks, her copay dropped to $4.90. She filled every prescription. Her blood pressure stabilized. Her doctor called it a “miracle.”
A veteran in Texas with diabetes and arthritis was paying $1,100 a year for his drugs before Extra Help. After qualifying, he paid $68. He started buying healthy food again. He lost 15 pounds. He said, “I didn’t realize I was living paycheck to paycheck until I stopped paying for pills.”
These aren’t rare cases. The Medicare Rights Center found that 68% of people who got Extra Help reported better medication adherence. That means fewer hospital visits, fewer emergencies, and longer, healthier lives.
Why Extra Help Is Still Underused
Despite saving an average of $6,200 per person per year, nearly 37% of eligible seniors aren’t enrolled. Why? Complexity. Confusion. Fear.
The application is long. The rules are confusing. People think they make too much. They don’t know about free help. They’re afraid of being denied.
But the truth is, most people who apply get approved. And if you don’t apply, you’re paying thousands more than you have to.
Don’t assume you’re not eligible. Don’t wait until you’re in crisis. Fill out the form. Ask for help. It’s not charity-it’s a right you’ve earned through your taxes and contributions.
What’s Coming Next
The Biden administration is pushing to expand Extra Help to people earning up to 175% of the Federal Poverty Level-that’s about $28,500 for a single person. If passed, over a million more seniors could qualify.
For now, the program remains the single most powerful tool for lowering prescription costs in Medicare. It’s simple, effective, and lifesaving. But only if you use it.
Do I have to reapply for Medicare Extra Help every year?
Yes. Every year in August, you’ll receive a renewal form from Social Security. You must return it within 30 days to keep your Extra Help benefits. If you don’t, your benefits end on January 1. Even if your income hasn’t changed, you still need to submit the form. Many people lose benefits simply because they ignore this step.
Can I still get Extra Help if I have savings in a bank account?
Yes, as long as your total countable resources don’t exceed $17,600 for an individual or $35,130 for a couple in 2025. Your primary home, one car, and personal belongings don’t count. Burial funds up to $1,500 are also excluded. But bank accounts, stocks, bonds, mutual funds, and IRAs do count. If you’re unsure, list everything on the application-Social Security will figure out what counts.
Does Extra Help cover brand-name drugs too?
Yes, but at a higher cost. In 2025, Extra Help beneficiaries pay $4.90 for generics and $12.15 for brand-name drugs. That’s still far less than the full price. But because generics are just as effective for most conditions, sticking with them saves you even more. Always ask your pharmacist: “Is there a generic version?”
Can I change my Medicare Part D plan if I have Extra Help?
Yes. Extra Help gives you a Special Enrollment Period that lets you switch Part D plans once every month. Changes take effect the first of the next month. This is useful if your current plan stops covering a drug you need or if a new plan offers better pricing on your generics. You don’t have to wait for the annual enrollment period.
What if I’m denied Extra Help-can I appeal?
Yes. If you’re denied, you have 60 days to appeal. You can request a reconsideration by calling Social Security or submitting a written request. Bring any documentation that shows your income or resources are lower than reported-like pay stubs, bank statements, or letters from benefit agencies. Many denials are overturned on appeal, especially if there was a mistake in the form.
