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Medicare Extra Help (LIS) Patient Guide: How to Get Your Prescription Drugs at Low or No Cost

Medicare Extra Help, also known as the Low-Income Subsidy (LIS), is a federal program that helps eligible Medicare beneficiaries pay for prescription drugs under Medicare Part D. It covers premiums, deductibles, and copays, making medications affordable or free for those with limited income and resources.[2][3]

Who Qualifies for Extra Help?

Extra Help is designed for Medicare enrollees who can't afford their prescription drug costs. You may qualify if you have Medicare Part D and your household income and resources fall below specific limits. Automatic eligibility applies if you receive Medicaid, Supplemental Security Income (SSI), or qualify for a Medicare Savings Program.[3][1]

Key factors include:

• Limited income (generally up to 150% of the Federal Poverty Level).
• Limited resources like bank accounts, stocks, or property (excluding your primary home).
• U.S. residency (higher limits in Alaska/Hawaii).[2][1]

Even if your income is slightly higher, you might still get partial help if you support dependents, work, or live in certain states.[1]

About the Program and Your Drugs

Extra Help works with your Medicare Part D plan to reduce out-of-pocket costs. Qualifying enrollees in 2026 pay:

• No Part D premiums or deductibles.
• No more than $12.65 for brand-name drugs and $5.10 for generics per prescription.[3]

The program doesn't provide specific drugs but subsidizes costs for any covered medication in your Part D plan. It's administered by the Social Security Administration (SSA) and averages $5,700 in annual savings per person.[3][7]

Income Eligibility Breakdown

Eligibility is based on 2026 Federal Poverty Guidelines. Use the table below to check your household. These limits adjust yearly and are uniform across most states (Alaska/Hawaii higher).[2][3]

Notes: Income includes wages, Social Security, pensions. Exclusions: food stamps, housing aid, certain tax credits.[1] Resources: bank accounts, stocks, IRAs (excludes home, car, life insurance).[1][2] Apply even if slightly over—exceptions for work earnings or dependents.[1]

Insurance Requirements

You must have Medicare Part D coverage. Those with Medicaid, SSI, or Medicare Savings Programs get automatic enrollment—no application needed.[3][8] If you have commercial insurance, explore manufacturer programs separately, as Extra Help focuses on Medicare.[5][6]

Medicare sends annual notices about continued eligibility. Coverage lasts the calendar year even if income changes mid-year.[2]

Step-by-Step Application Process

1. Check Automatic Eligibility: Confirm if you get SSI/Medicaid—contact SSA at 1-800-772-1213.[3]
2. Gather Documents: Proof of income (tax returns, pay stubs), resources (bank statements), Medicare ID, household details.[1][7]
3. Apply Online: Visit SSA.gov/ExtraHelp or download Form SSA-1020.[7] Answer for yourself/spouse.
4. Mail or Call: Send to SSA or call 1-800-MEDICARE (1-800-633-4227).[2]
5. Assistance: Use SHIP counselors or NCOA resources for free help.[3]

Processing takes 4-6 weeks typically.[2]

Timeline and Delivery

• Approval: 4-6 weeks; you'll get a notice detailing benefits and plan options.[2]
• Ongoing: Automatic renewal if eligible; reapply if income changes.[2]
• Delivery: Benefits apply at any Part D pharmacy—no separate delivery. Pick up meds as usual with reduced copays.[3]

Alternatives if Denied or Ineligible

• Manufacturer Programs: AbbVie, GSK offer free meds for uninsured/low-income (e.g., AbbVie: $62,600 for household of 1).[5][6]
• State Programs: NYC Rx Assist, NeedyMeds.org for discounts.[4]
• Discount Cards: New York Rx Card for uninsured.[4]
• Reapply: If circumstances change or errors found.[1]
• Appeals: Contact SSA for review.[7]

Disclaimer

This guide provides general info based on 2026 guidelines and is not official advice. Eligibility varies; contact SSA/Medicare for personalized help. Limits change annually—verify current figures. Not a substitute for professional financial/medical advice. Program details from SSA/Medicare sources.[1][2][3]