Official Medicare Publications & Guides

Extra Help with Medicare Drug Costs: SSA Publication 05-10508

The SSA's January 2026 guide on Extra Help with Medicare prescription drug costs explains who qualifies, how to apply, and what to expect. This program is worth up to $5,700 per year and covers premiums, deductibles, and co-pays for eligible Medicare beneficiaries.

Jan 31, 2026 · 5 min read

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Who Should Read This

This publication is most useful for people who have Medicare and are struggling to afford their prescription drug costs. If you are 65 or older and enrolled in Medicare Part D, or if you will be turning 65 soon and are on a fixed or limited income, this guide speaks directly to your situation. It is also relevant for people under 65 who qualify for Medicare due to a disability.

Married couples living together will find this especially helpful, since eligibility is based on combined household income and resources. Caregivers, adult children, and other family members who help a loved one manage their Medicare coverage should also read this — the publication includes a dedicated section on how third parties can help someone apply. American Indians and Alaska Natives are called out specifically for additional exclusions that may work in their favor.

Quick Overview

This Social Security Administration publication explains the Extra Help program, which helps Medicare beneficiaries with limited income and resources pay for their prescription drug coverage under Medicare Part D. It walks readers through eligibility rules, the application process, how to choose a drug plan, how annual reviews work, and what to do if a decision is appealed. The publication is written in plain language and is 14 pages long, making it an accessible and practical reference.

Key Takeaways

Extra Help is estimated to be worth about $5,700 per year per person in savings on prescription drug costs, including premiums, deductibles, and co-payments.
To qualify in 2026, resources must be $18,090 or less for an individual, or $36,100 or less for a married couple living together.
The annual income limit is $23,475 for an individual and $31,725 for a married couple — though some people with higher income may still qualify depending on their circumstances.
Many common assets are excluded from the resource calculation, including your home, your vehicle, personal possessions, life insurance policies, and burial expenses.
Applications can be submitted online at ssa.gov, by phone at 1-800-772-1213, or in person at a local Social Security office.
People who receive Extra Help are not subject to the Medicare Part D late enrollment penalty.
Eligibility is reviewed annually, typically in late August, and failure to respond to a review notice will result in Extra Help being stopped the following year.

Publication Summary

The SSA's January 2026 publication on Extra Help with Medicare Prescription Drug Plan Costs is a comprehensive guide covering every major aspect of this important low-income assistance program. Here is a detailed look at what the publication covers.

What Extra Help Is and Why It Matters

Extra Help — also known as the Low Income Subsidy — is a federal program that helps Medicare beneficiaries pay for Part D prescription drug costs. These costs include monthly premiums, annual deductibles, and prescription co-payments. The program is administered by the Social Security Administration and is estimated to be worth about $5,700 per year. Many people who qualify are simply unaware that this benefit exists, which is one of the key reasons SSA publishes this guide.

Resource and Income Limits

To be eligible for Extra Help, an individual must have resources of $18,090 or less, and a married couple living together must have combined resources of $36,100 or less. Resources include bank accounts, stocks, bonds, mutual funds, IRAs, cash on hand, and real estate other than a primary home. Importantly, the publication makes clear what does not count as a resource: your home, your vehicle, personal possessions, life insurance policies, burial expenses, and certain other items that cannot easily be converted to cash.

On the income side, an individual's annual income must generally be $23,475 or less, and a married couple's combined income must be $31,725 or less. However, the publication notes that people with income above these limits may still qualify in certain situations — for example, if they support other family members living with them, have earnings from work, or live in Alaska or Hawaii. Not all income counts either. Food stamps, housing assistance, home energy assistance, earned income tax credit payments, disaster assistance, and scholarships are excluded from the income calculation.

Applying for Extra Help

Applying is straightforward. The publication directs people to complete Form SSA-1020, which can be submitted online at SSA's Website, over the phone by calling 1-800-772-1213, or in person at a local Social Security office. The online application walks users through the process step-by-step and can be started and stopped at any time, making it accessible even for those who are not tech-savvy.

Before applying, it helps to gather information about all household income sources and to review the value of assets owned individually or jointly. If approved, the applicant can then choose a Medicare Part D drug plan. If no plan is selected, the Centers for Medicare & Medicaid Services will automatically assign one.

Late Enrollment Penalty Protection

One of the most valuable but least understood benefits of Extra Help is protection from the Medicare Part D late enrollment penalty. Normally, if a person does not enroll in a Part D plan when first eligible, they may owe a penalty added to their premium for as long as they remain enrolled. People with Extra Help are exempt from this penalty, which can represent meaningful long-term savings.

Plan Selection Guidance

The publication guides readers on how to choose a Medicare drug plan by visiting Medicare.gov to compare options. Key factors to consider include coverage (whether the plan's formulary includes the specific drugs a person takes), cost (how premiums and co-payments vary between plans), and convenience (whether the plan works with nearby pharmacies).

State Programs and Medicaid

Applying for Extra Help also initiates a referral process for Medicare Savings Programs, which are state-run programs that can help cover Medicare Part B premiums and, in some cases, Part A premiums and cost-sharing. SSA automatically forwards applicant information to the relevant state agency unless the applicant asks them not to.

Annual Reviews and Appeals

Extra Help eligibility is reviewed every year, typically in late August. If selected for review, a beneficiary will receive Form SSA-1026 and must return it within 30 days. Any adjustments take effect in January of the following year. If Extra Help is denied or reduced, the publication details a clear appeals process, including the right to request a telephone hearing or a case review within 60 days of receiving the decision notice.

Frequently Asked Questions

Does owning a home affect my eligibility for Extra Help? No. A primary residence is not counted as a resource for Extra Help eligibility purposes. Vehicles, personal possessions, and life insurance policies are also excluded.

What happens if I do not pick a Medicare Part D plan after being approved for Extra Help? If no plan is selected, CMS will automatically enroll the applicant in a plan. The publication encourages people to choose their own plan as quickly as possible so that benefits can begin sooner.

Can a family member apply on behalf of a Medicare beneficiary? Yes. Family members, caregivers, and other third parties can assist with the application. The person helping must answer questions as if the beneficiary were completing the form themselves, using that person's income and resource information.

What if my income is higher than the listed limits? It is still worth applying. Some income types are excluded from the calculation, and people who support family members, have work earnings, or live in Alaska or Hawaii may qualify even with a higher reported income.

What if I disagree with a decision about my Extra Help eligibility? There is a formal appeals process. A person has 60 days from receiving the decision notice to file an appeal using Form SSA-1021. A telephone hearing or case review will be scheduled. If still unsatisfied, a lawsuit may be filed in federal district court.