Medicare Extra Help (LIS): 2026 Income Limits, Benefits, and How to Apply

What Is Medicare Extra Help (LIS)?

Medicare Extra Help, formally called the Low Income Subsidy (LIS), is a federal program run jointly by the Social Security Administration and the Centers for Medicare & Medicaid Services. It helps people with limited income and resources pay Medicare Part D prescription drug plan premiums, deductibles, coinsurance, and other drug-related costs.

Extra Help only pays for Part D prescription drug costs, not for Part A hospital or Part B medical services. For help with those, you need one of the Medicare Savings Programs instead. Many people qualify for both.

The program is enormously valuable. The Social Security Administration estimates Extra Help is worth about $5,700 per year to a typical enrollee who fills prescriptions regularly. And thanks to changes from the Inflation Reduction Act, everyone who qualifies now receives the full benefit; the old partial subsidy category was eliminated.

2026 Income and Resource Limits

Eligibility for Extra Help has two tests: an income test and a resource (asset) test. You must pass both.

Income limits

For 2026, the income limit is 150% of the Federal Poverty Level. In the 48 contiguous states and DC, that works out to:

Alaska and Hawaii use higher federal poverty guidelines, so the Extra Help income limits are correspondingly higher in those two states. Income includes Social Security benefits, pensions, wages, and other regular payments, with a standard $20 monthly disregard applied to unearned income.

Resource (asset) limits

The CMS resource limits for 2026 are:

These figures include an allowance for burial expenses (up to $1,500 per person). Countable resources include checking and savings accounts, cash, stocks, bonds, mutual funds, IRAs, and real estate other than your primary home.

What is not counted:

• Your primary residence, regardless of value
• One vehicle
• Personal belongings and household items
• Burial plots and certain burial funds (typically up to $1,500 per person)
• Small-face-value life insurance policies

What Extra Help Pays in 2026

Since the Inflation Reduction Act eliminated the partial subsidy tier, everyone who qualifies for Extra Help now gets the full benefit. In 2026, that means:

Part D premium: $0

Extra Help pays your Part D premium up to the regional "benchmark" amount (the average of the low-cost plans in your area). If you enroll in a benchmark plan, your monthly premium is $0. If you choose a plan whose premium is above the benchmark, you pay only the difference.

Deductible: $0

Standard Part D plans in 2026 have a $615 deductible. With full Extra Help, that deductible is $0. You start paying only the reduced copays from your very first fill.

Copays: capped at pennies on the dollar

At participating pharmacies you pay no more than:

• $5.10 for each generic drug
• $12.65 for each brand-name drug

If you also have full Medicaid and are in the Qualified Medicare Beneficiary (QMB) program, your copay for any covered drug drops to no more than $4.90, and can be as low as $1.60 for generics if your income is below 100% of FPL.

$0 after the catastrophic threshold

Once your total drug costs (including payments made on your behalf through Extra Help) reach $2,100 in 2026, you pay $0 for each covered drug for the rest of the year.

Extra Help vs. Medicare Savings Programs

Extra Help and the Medicare Savings Programs are separate but complementary. Confusing them is one of the most common mistakes people make when researching help with Medicare costs.

The simplest way to remember it:

• Extra Help = Part D drug costs
• Medicare Savings Programs = Part A and Part B medical costs

The Medicare Savings Programs are Medicaid-administered benefits that help cover Medicare premiums and, for some enrollees, deductibles, coinsurance, and copayments for Parts A and B. There are four MSPs: QMB, SLMB, QI, and QDWI. QMB is the most comprehensive and pays your Part B premium plus all Part A and B deductibles and cost-sharing.

Here is a side-by-side view:

The key link between them: enrolling in any MSP (QMB, SLMB, or QI) automatically qualifies you for Extra Help. Unfortunately, the reverse is not true. Getting Extra Help does not automatically enroll you in an MSP; you must apply separately through your state Medicaid agency.

Who Qualifies Automatically (Deemed Eligible)

Three groups of Medicare beneficiaries are "deemed" eligible for Extra Help automatically and never need to file an application:

1. Full-benefit dual eligibles. If you have both Medicare and full Medicaid coverage, you are deemed eligible.
2. Medicare Savings Program enrollees. Enrollment in QMB, SLMB, or QI automatically triggers Extra Help.
3. Supplemental Security Income (SSI) recipients. If you get SSI cash benefits and have Medicare, you are deemed in.

CMS identifies these individuals through data feeds from state Medicaid agencies and SSI records. If you have not selected a Part D plan, CMS will auto-enroll you in one so your Extra Help benefit starts right away. You can switch to a different Part D plan at any time.

If you are automatically enrolled but do not see the Extra Help pricing at the pharmacy, call 1-800-MEDICARE and ask the pharmacist to check your LIS status in the plan's system.

How to Apply for Extra Help

If you are not deemed automatically eligible, you must apply. Applying is free and can be done any time of year.

Option 1: Apply online (fastest)

Go to ssa.gov/extrahelp and complete Form SSA-1020, the Application for Extra Help with Medicare Prescription Drug Plan Costs. The online application takes 15-30 minutes if you have your paperwork in front of you. You can save your progress and return later, and you'll get a confirmation number at the end.

Option 2: Apply by phone

Call Social Security at 1-800-772-1213 (TTY 1-800-325-0778), Monday through Friday. A representative will complete the SSA-1020 with you over the phone.

Option 3: Apply in person or by mail

Visit your local Social Security office, or request a paper SSA-1020 form and mail it back.

Documents to gather

Before you start, collect:

• Your Social Security number (and your spouse's, if married and living together)
• Recent bank statements for all checking and savings accounts
• Statements for investment accounts, IRAs, 401(k)s, stocks, and bonds
• Most recent pay stubs, pension statements, or tax return
• Information about any regular financial support from family or friends
• Details on burial funds set aside and mortgage or rent amount

After you apply, Social Security will mail you a decision letter within a few weeks explaining whether you qualify.

How Spousal Income Affects Eligibility

If you are married and living with your spouse, Social Security counts your combined income and combined resources against the couple's limits ($32,460 income and $36,100 resources for 2026). Your spouse's earnings, Social Security check, pension, and countable assets all get added to yours.

If you are married but living apart, Social Security typically evaluates you as an individual, and your spouse's income and resources may not be counted. This is fact-specific, so tell Social Security about your living arrangement clearly on the application.

Major life changes such as divorce, legal separation, or the death of a spouse can dramatically change your eligibility picture. If you were previously denied because of combined income, you can reapply after a qualifying change.

What Happens If You're Denied

A denial is not the end of the road. You have the right to appeal.

• Deadline: File your appeal within 60 days of receiving the denial letter (Social Security assumes you got it 5 days after the date on it).
• Form: Complete Form SSA-1021, Appeal of Determination for Help with Medicare Prescription Drug Plan Costs.
• How to file: Mail the form to the address provided, or call/visit any Social Security office.
• Format: You can choose a telephone hearing (where you explain your case to an appeals officer who did not participate in the original decision) or a case review (a paper-only review of your file plus any new evidence you submit).

Bring updated documentation: recent bank statements, corrected income figures, or proof of a change in marital or living situation. If you are denied a second time and remain unhappy with the outcome, you can file suit in federal district court, though most cases are resolved at the SSA level.

You can also reapply at any time if your income drops, your assets decrease, or your household situation changes. Extra Help is not one-and-done; you can try again as often as your circumstances warrant.

Actionable Next Steps

If you think you might qualify:

1. Check your rough eligibility. Are your monthly income and countable assets below the 2026 limits? If close, apply anyway.
2. Apply online at ssa.gov/extrahelp, it takes about 20 minutes.
3. Also apply for a Medicare Savings Program through your state Medicaid agency. Read our full guide to MSP income limits and QMB/SLMB rules to see which program fits.
4. If you're denied, file Form SSA-1021 within 60 days. Include any updated income or asset documentation.
5. Contact your local State Health Insurance Assistance Program (SHIP) for free one-on-one help completing either application.

Frequently Asked Questions

Does Extra Help pay my Part D premium?

Yes, Extra Help pays your Part D monthly premium in full up to the regional benchmark amount. If you enroll in a benchmark plan (a plan whose premium is at or below your region's benchmark), you pay $0 per month. If you choose a plan whose premium is above the benchmark, Extra Help still covers the benchmark portion and you pay only the difference.

Can I get Extra Help if I have a retirement account or IRA?

Yes, but the balance counts as a resource. Your combined countable assets must be under $18,090 for an individual or $36,100 for a couple in 2026. Your primary home and one vehicle do not count, but IRAs, 401(k)s, and other investment accounts generally do. Some people become eligible after they spend down or annuitize a retirement account.

What is the difference between full and partial Extra Help in 2026?

There is no longer a distinction. Thanks to the Inflation Reduction Act, everyone who qualifies for Extra Help now receives the full subsidy. The old partial LIS tier was eliminated, meaning more people receive $0 premiums, $0 deductibles, and the lowest copays.

Do I have to apply for Extra Help every year?

No. Once you are enrolled, your Extra Help continues year to year unless your income or resources change significantly. Social Security may send you a redetermination form periodically (usually every few years) to verify you still qualify. If you're automatically deemed eligible through Medicaid, MSP, or SSI, your Extra Help status is renewed automatically as long as you stay in one of those programs.

Can I switch Part D plans if I have Extra Help?

Yes. Extra Help enrollees get a Special Enrollment Period that allows them to change Part D plans once per calendar quarter during the first nine months of the year (January through September), plus during the fall Annual Enrollment Period. This flexibility is unique to Extra Help enrollees and lets you switch to a benchmark plan (for a $0 premium) or to a plan that better covers your specific medications.