Who Qualifies for Extra Help With Medicare?

Medicare’s Extra Help program, also known as the Low-Income Subsidy (LIS), is a federal assistance program that helps people with limited income and resources cover the cost of their Medicare Part D prescription drug plan.

In this guide, we’ll break down who qualifies for Extra Help Medicare, what the program typically covers, how to apply, and the income and asset limits that usually apply.

What Is Medicare Extra Help?

Medicare Extra Help is a federal program that helps reduce out-of-pocket costs for prescription medications under Medicare Part D. If you're struggling to afford your monthly premiums, deductibles, or co-pays for medications, Extra Help can usually significantly lower those costs.

Who should consider Medicare Extra Help?

Anyone enrolled in Medicare with limited income and financial resources, especially those struggling with the rising cost of prescriptions, should check their eligibility for this program.

Also referred to as the Low-Income Subsidy (LIS), Extra Help can provide significant financial relief. Here's what the program typically covers:

• Monthly Part D premiums

• Annual deductibles

• Prescription drug co-pays or coinsurance

• Elimination or reduction of the Part D late enrollment penalty

Who Automatically Qualifies for Extra Help With Medicare?

You may not need to apply if you meet certain conditions. Individuals automatically qualify for Extra Help if they fall into one of the following categories:

• Dual-Eligible Beneficiaries: You’re enrolled in both Medicare and full Medicaid coverage.

• SSI Recipients: You receive Supplemental Security Income (SSI) benefits through Social Security.

• Medicare Savings Program Participants: You’re enrolled in a Medicare Savings Program like QMB (Qualified Medicare Beneficiary), SLMB (Specified Low-Income Medicare Beneficiary), or QI (Qualifying Individual).

If you fall into one of these groups, you should receive a notice from Medicare about your automatic eligibility.

Who Needs to Apply for Extra Help?

If you don’t automatically qualify, you can still apply based on your income and resource levels.

To apply, you must:

• Have Medicare Part A and/or Part B

• Reside in one of the 50 U.S. states or the District of Columbia

• Meet income and resource requirements

You’ll need to submit an application either:

• Online through the Social Security Administration (SSA), SSA.gov, through your state’s Medicaid agency

Applications typically ask for your income, resources (bank accounts, stocks, etc.), and living situation.

What Counts as a Resource (and What Doesn’t)?

When applying, your resources will be reviewed to determine eligibility. Here's what counts, and what doesn’t.

Resources That Count Toward the Limit:

• Bank accounts (checking/savings)

• Stocks and bonds

• Mutual funds

• Real estate (excluding your primary home)

Resources That Are Exempt:

• Your primary residence

• Personal belongings, including furniture and household items

• Your vehicle(s)

• Life insurance policies

• Certain types of property are needed for self-support

How to Apply for Extra Help Medicare

If you need to apply manually, here’s how to get started:

1. Apply online through the SSA

Visit the Social Security Administration Extra Help application page to complete your application quickly and securely.

2. Apply through your local Medicaid office

If you prefer, you can apply through your state Medicaid agency, especially if you’re applying for other assistance programs at the same time.

Important Note:

The SSA may contact you for additional documentation or verification, so be sure to check your mail and respond promptly to avoid delays.

FAQs About Qualifying for Extra Help

Can I qualify if I don’t get Medicaid?

Yes. You don’t need to be enrolled in Medicaid to qualify. As long as you meet the income and resource limits, you may be eligible.

What if my income changes during the year?

If your income increases or decreases significantly, report the change to SSA or your Medicaid office. It could affect your eligibility or benefit level.

Will my eligibility be reviewed annually?

Yes. Eligibility is reviewed each year to ensure your income and resources still fall within the approved limits.

Can I apply on behalf of someone else?

Yes. Family members, caregivers, or legal representatives can help someone apply, especially if the individual is unable to complete the application themselves.

Conclusion

If you’ve ever asked, “Who qualifies for Extra Help Medicare?”, now you know: eligibility is based on income, resources, and specific circumstances like Medicaid enrollment or SSI status. Even if you don’t qualify automatically, applying could save you hundreds of dollars per year on prescription drug costs.

If you need additional support, our licensed agents at Unified Health are here to help! 

MULTIPLAN_UH_25114_C